By Jill Rackham Life beyond cancer has given me a little Demon in my head. Having a mirror held up to my own mortality left me with some feelings I dread. Christmas makes my Demon super active and full of thought. Reminding me of my challenges and the new normal cancer brought. At times the Demon goes quiet but Christmas seems to make him talk nonstop. Reminding me of Christmases gone by, the overwhelming thoughts make my mind want to pop. Sadness, anxiety, disbelief and a feeling that life can be so unfair. The Demon is great at bringing me these, but at Christmas... really I despair! So onwards and upwards in life I always strive to go. Hoping the Demon will leave me so happy thoughts can flow. I'm wishing for a joyful time this Christmas by creating new memories with my family. Going for walks, lots of chatting, eating chocolates, watching a film or three. Each Christmas post cancer definitely has a new meaning to me. I'm much more reflective and appreciate life, embracing all that is to be! So along with many others living beyond cancer we do the best we can. Holding onto a positive mental attitude I think is the best plan. Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Life threw me a curveball, and I handled it the best way I could, with dignity and grace. The mountains I had to climb now seem like bumps in the road. I was given terrible news — "you have cancer," but it wasn't the end of the world. I underwent multiple rounds of chemotherapy, I had been pricked and probed with shots and IVs, I had invasive surgery, and was zapped with radiation for 6 weeks. All of these things were part of the plan; I knew they were coming. But what I was not expecting was how challenging returning to the workforce would be. This was supposed to be the easy part, right? The return to work (albeit while still undergoing treatment) is now just the next phase in the recovery process. However, I think there are a few things to acknowledge, maybe break down some misnomers, and offer personal advice as I reflect on my first week back. 1. You are Back At Work, So are You All Better Now? The good news, yes, I am better and able to return to work, and that is a great sign! However, depending on one's cancer journey, there still may be a lot that the person is enduring behind the scenes. Some people may be open about their health journey with coworkers, while others may keep it close to the vest. I think it is a good reminder that even though someone may look "healthy" and "all better" on the outside, there may still be a lot of pain on the inside. In my case, I am glad to be returning to work because, yes, things are returning to normalcy. But that doesn't mean I'm magically "cured." There are a number of "medical cocktails" I continue to take to ensure that breast cancer does not recur! 2. Understanding Your Sense of Self The American Cancer Society suggests that returning to work helps promote a sense of self, purpose, and reminds one that they have a life outside of cancer. There are a lot of benefits that come from these daily interactions with colleagues. However, I want to bring to light that it can also be scary, and that's OK too! As someone who went through cancer treatments, I do feel different. I do feel like my perspective on life has changed, and although the circumstances of cancer were not ideal, this experience has forever changed and shaped me. There is acceptance and peace that comes with understanding yourself as a survivor. 3. Those Who Plan Achieve Rethink Pink offers 5 valuable tips for transitioning back to the workforce, and planning makes all the difference! Work can be stressful and induce anxiety on a normal day, let alone returning to work after going through such a life-altering health event. A few tips that have helped me profoundly were centered around planning! For example, I rehearsed scripts. I knew a lot of colleagues would be visiting my office to say hello. This was fantastic, but I had to decide (prior) what information about my journey I was going to share. Did they need all of the grueling details? Probably not. I picked a few funny stories about losing my eyelashes, or the new "punk rock" hairstyle I was rocking, and everyone had a good laugh. You cannot take yourself too seriously — humor is key! Also, be sure to connect with your boss and HR. You have a lot of rights and protections, which can also help if you are looking for accommodations as you return. In the U.S., we have the Rehabilitation Act and the Americans with Disabilities Act (ADA). Some people also benefit from the Family and Medical Leave Act (FMLA). 4. Managing Chemo Brain What was once debated as not being a legitimate side effect from chemotherapy, oncologists now acknowledge that chemo brain is a real condition impacting one's cognitive ability for up to 6 months post-treatment, according to a 2017 study . We all want to perform well at work. Therefore, I have started to incorporate a few daily habits to offset this side effect. First, I am not afraid to take notes or even ask colleagues if I can record a meeting, so that I can listen to it again later and ensure I have captured all of the key takeaways. I also set aside time at the end of the day to make a task list of where I left off on various projects and what priorities are set for tomorrow. This has been extremely helpful because now, when I walk into my office each morning, all of my notes, tasks, and to-dos are right there waiting for me. It not only helps with chemo brain, but it also reduces stress and anxiety! 5. Finally, Let's Take Some Time to Breathe The breath is one of the most powerful tools we have and is often underutilized. When was the last time you took a deep breath? You know, one of those breaths that fills up your entire lung cavity and travels deep down into your inner belly? Unless you are taking a big sigh of relief, or in a yoga class, taking big belly deep breaths are not unconscious acts. When you take longer inhales and exhales, you are immediately sending signals to your mind which trigger the nervous system to return to a state of calmness . While we may not all have time to attend a yoga class or sit still and meditate, I would recommend practicing breathing techniques if you notice yourself becoming anxious, heading into a meeting, or before responding to emails. Within seconds, you become more mindful and back in control, empowered to tackle the day! #BreastCancer #Returningtowork #Work #Cancer

It is well documented that physically active women have a lower risk of breast cancer than do others who are not. Thus, it stands to reason that physically active breast cancer survivors may reduce the risk of cancer’s return and dramatically improve quality of life. As always, consult your oncological team before starting out on your fitness program. Exercise is Safe Per Breastcancer.org (one of the attached links below), “a roundtable convened by the American College of Sports Medicine in 2010 reviewed available research and concluded that exercise is safe during and after all breast cancer treatments (as long as you take any needed precautions and keep the intensity low) and improves physical functioning, quality of life, and cancer-related fatigue. There is also evidence that exercise can help breast cancer survivors live longer and lead a more active life.” Risk Reduction According to Cancer.gov (link below), “studies show that physically active women have a lower risk of breast cancer than inactive women. Physical activity has been associated with a reduced risk of breast cancer in both premenopausal and postmenopausal women; however, the evidence for an association is stronger for postmenopausal breast cancer.” This study further elaborates on how exercise can reduce the risks of cancer and its recurrence: Exercise has a number of biological effects on the body, including: Lowering the levels of hormones, such as estrogen, and of certain growth factors that have been associated with cancer development and progression Helping to prevent obesity and decreasing the harmful effects of obesity Reducing inflammation Improving immune system function Cognitive Impairment (“chemo brain”) Furthermore, a new study (found in the ScienceDaily.com link below) “indicates that cancer patients and survivors have a ready weapon against fatigue and "chemo brain": a brisk walk. Their data suggests “that being more physically active could reduce two of the more commonly reported symptoms in breast cancer survivors: fatigue and cognitive impairment." Cognitive impairment, such as memory problems or shortened attention spans, is a common complaint among cancer patients and survivors, and is thought to be similar to decline due to aging. Fitness Recommendations With the above (and below) referenced studies in mind, we at Survivingbreastcancer.org are recommending the following exercise possibilities: Walking: The health effects of a brisk walk cannot be overstated, notably for cognitive impairment, but also for the muscular and circulatory systems. Yoga: This discipline combines stretching, deep breathing, and toning of the muscular system, and offers a wonderful way to relax the nervous system. Meditation: According to Laura-Sage (link below), meditation can effectively reduce stress, anxiety, depression, fatigue, and fear of recurrence. It can also help reduce hot flashes. Weight resistance & training program: In another recent study, researchers looked at data from the Physical Activity and Lymphedema (PAL) trial to determine whether slowly increased weight lifting could increase muscle strength among breast cancer survivors and help them avoid frailty and maintain physical function. Aerobic and cardio training (swimming, running, elliptical, stairmaster, etc.): Lastly, another recent study (for the NIH) showed that a “10-week moderate-intensity aerobic exercise program significantly improves quality of life and physical functioning in breast cancer survivors.” Please note that further long-term studies have been recommended. We found the following links to be beneficial: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet https://www.scribd.com/document/268275865/Breast-cancer-and-physical-activity https://www.acefitness.org/education-and-resources/lifestyle/blog/6753/exercise-for-breast-cancer-survivors https://www.sciencedaily.com/releases/2017/07/170725122242.htm https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm#ReduceCancer https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/physical-activity-and-the-cancer-patient.html http://www.breastcancer.org/tips/exercise https://community.breastcancer.org/forum/44/topics/836196 http://www.lbbc.org/building-and-restoring-physical-fitness-after-breast-cancer https://www.mindbodygreen.com/articles/what-you-need-to-know-about-exericse-and-cancer https://www.huffingtonpost.com/laura-sage/5-benefits-of-meditation_b_10617412.html https://www.cancer.org/.../study-weight-lifting-helps-breast-cancer-survivors-stay-health... https://www.ncbi.nlm.nih.gov/pubmed/25313756

One of the many FAQs that we have been asked at SurvingBreastCancer.org is “How should I deal with side effects, i.e., to lessen their impact and eliminate them entirely?” There are many potential side effects to chemotherapy. The shortened list includes nausea, vomiting, loss of appetite, dehydration, mouth sores, fatigue, diarrhea, constipation, water retention, “chemo brain,” and hair loss. Of course, you should always notify your oncological team of any side effects that you may be experiencing. In this blog, I’d like to address six of the most commonly experienced side effects that I and my cohort have faced, and typically how we have dealt with them. 1. Hair Loss Hair loss is quite common and can be quite an emotional tug. This occurs in most cases within 6 weeks from the start of chemo, depending on the treatment, and should start to return shortly after the cessation of chemotherapies. There are a few notable ways to lessen the impact, but typically, if you are going to lose your hair, it may behoove you to take a graduated approach. I’ve found that cutting my hair quite short after the start of chemo was a very helpful first step. Cutting my hair short was something I would never do otherwise, so this was my chance to try out a fun pixie cut with no risks! Shortly after starting Adriamycin and Cytoxan (AC) treatment (aka the “red devil”), clumps of my hair started to fall out. At this phase, I wasn’t sad to lose my hair; rather, I was frustrated at how annoying it felt every time I put on a shirt and wisps of hair would fall out; every time I ran my fingers through my hair, more wisps would fall out. Imagine those tiny little hairs after a haircut falling out everywhere, shedding like a cat. So, feeling empowered to take control of the situation, I shaved my head. Don’t spend tons of money on this type of haircut. I literally went to a barber shop and asked them to shave it all off. The barber was initially confused and asked if I wanted any sort of etching or designs. As innocent as the question was, I explained that I was sick and I was taking it all off! Other, less drastic remedies include: Use mild moisturizing shampoos and conditioners – avoid harsh chemicals Use a soft brush Wear a scarf, wig, or hat. I chose to rock the bald look, and it helped me to accept my condition. Note: I also shared my diagnosis and treatments on YouTube and other Social Media, so this choice may not be for you. While everyone associates losing hair on your head as the only place you will lose it, don’t be surprised if you start to lose hair on your legs, under your arms, as well as your nose hairs, eyelashes, and eyebrows, etc. Take care of your scalp by lubricating and protecting it from the sun. I found tea tree and castor oil to help my hair follicles grow faster! 2. Fatigue Physical fatigue is a common side effect and typically starts when commencing chemotherapy. Ongoing exhaustion and/or overall weakness can prevent one from performing normal/routine tasks and activities. And just as importantly, it can contribute to the emotionality of dealing with cancer. What follows is a list of ways to mitigate fatigue: Rest is more than appropriate and should become part of your everyday routine. Naps are highly encouraged Additionally, an exercise regimen is strongly recommended (be sure to consult with your medical team to determine the limitations of your workouts. Walking and swimming are two of the best ( See our previous blog on exercise ). As counterintuitive as it sounds, getting 30 minutes of exercise a day helps combat the symptoms of fatigue. Don’t be afraid to ask for help, i.e., grocery shopping, housecleaning, errands, etc. Proper nutrition/diet goes a long way to alleviate fatigue (see our nutrition blog). Also, lean on your support group, parents, significant others, or roommates to be your advocates. I have a hard time saying no, and I love being social, having friends over, and entertaining. However, my caregiver got to play the “bad cop,” reminding people that I am fighting cancer, and sometimes the answer had to be “she needs her rest.” Personally, I came to really appreciate this. It took the pressure off of me knowing that my caregiver had my best interest and realized when I was easily becoming overtaxed. 3. Nausea and Vomiting Stomach issues represent another side effect and are attributable to chemo damage to healthy cells in your stomach and gastrointestinal tract. The following recommendations may offset both: Avoid hot spicy foods. Eliminate or greatly reduce the garlic, chili oils, and hot peppers, and cool down your exotic foods. I have gone so far as to request mild Indian, Thai, and Mexican foods, which is something I never thought I’d do. Bland foods are easier to handle. Easy examples include: Saltine crackers Toast Cereals This is a case where bland is better. Another trick I found helpful was to suck on hard candies and utilize ginger in my juices and smoothies. I also found it important to reduce the size of your meals. Eat smaller portions and more often more often. Drink plenty of water. I’ve gone so far as to measure my water intake and set goals that approached 120 oz daily. Hydration is key! If these natural remedies do not help and the nausea persists, talk to your medical care team. They may prescribe steroids to help manage this condition. I was on Decadron (http://www.chemocare.com/chemotherapy/drug-info/decadron.aspx), Compazine, and Zofran, which helped me tremendously! Acupuncture and natural supplements may also help. More on these treatments in a follow-up blog. 4. Mouth Sores These are common inside the mouth and along the throat. These can be painful and make it difficult to swallow. The ways to mitigate and or remediate include: Gargling with salt water Avoiding hot spicy foods Staying away from tomato-based sauces Refraining from tobacco and or minimizing alcohol Use a non-alcohol-based mouthwash Change your toothbrush often 5. Gastrointestinal Irritation (Diarrhea/Constipation) can result from chemotherapy damage to the lining of your stomach and intestines. Severe diarrhea can be quite dangerous, and one should get treatment ASAP to resolve it. Typically, patients may experience watery stools at first, and the following remedies may eliminate or reduce the severity: Stay hydrated. As mentioned above, drink plenty of water. Minimize milk and other dairy products. Try yogurt for its bacterial cultures. Avoid fatty food, choose easy-to-digest foods, and eat smaller portions several times daily. A lot of times, breast cancer patients mention that their diets have changed, and that is because so much of our bodies are changing at warp speed as chemotherapies are working their magic. If you are in your first few weeks of a chemo regimen, it may take trial and error to see which combinations of foods agree with your stomach. Here is a list of foods that can cause binding and lead to constipation: Bananas Red Meat Dairy Fried foods Processed grains Here is a list of foods that can cause loose stools and lead to diarrhea: Dairy products Greasy foods Onions Corn Citrus fruits 6. Hot Flashes As a premenopausal woman of 36 years old, I cannot leave off the list of chemo side effects, the dreaded hot flash! Chemotherapy destroys fast-dividing cancer cells, and according to Breastcancer.org, it can be harmful to your ovaries. As a result, younger women may notice that their menstrual cycle stops and they experience medically induced menopause. Unlike older women who enter menopause over the course of several years, younger women are thrown into this state in a matter of weeks! As such, menopause-like side effects associated with chemotherapy treatments can be surprising and unpleasant. One of the most common is hot flashes. While it is not clear what exactly causes hot flashes, studies suggest that it is most commonly due to chemical changes in the body. Therefore, if you are estrogen receptor-positive (ER+) and your treatment plans require the reduction or elimination of estrogen and/or ovarian suppression from Lupron or Zoladex , then it stands to reason that medically induced menopause and hot flashes are common side effects. Hot flashes (or night sweats) are sudden changes where you may feel red, hot, flushed, or even experience severe sweating anywhere from 1 to 10 minutes. While there is no magic cure for eliminating hot flashes, here are a few tips on how to reduce their severity: Notice what triggers hot flashes. A lot of times, it can be linked to certain foods like spicy entrees, garlic, caffeine, or alcohol. Dress in layers. Invest in tank tops or t-shirts that are made with wicking material; they are loose and wick away sweat to help you stay comfortable. I personally loved PJs from Cool Jams . Take a cool shower before bed; this will take away any sweat from the day, so you are not freezing at night, and also helps you remain cool so you can fall asleep. Finally, discuss with your medical care team! While they may not be able to prevent hot flashes, they may offer a prescription which could help, for example, Gabapentin. There are many more tips and many more side effects one may be exposed to when experiencing chemotherapy. Post a comment below of what you are experiencing, and I will be sure to include information in our upcoming blogs on chemotherapy. In the meantime, here is a list of helpful links that I found quite helpful: 12 Tips & Tricks to Get You Through Chemotherapy - My Cancer Chic www.mycancerchic.com/12-tips-tricks-to-get-you-through-chemotherapy/ Ten tips for getting through chemo - Breast Cancer Care https://www.breastcancercare.org.uk/information.../ten-tips-getting-through-chemo 11 Tips to Get Through Chemotherapy - Oprah.com www.oprah.com/health/11-tips-to-get-through-chemotherapy Tips for Managing Chemotherapy Side Effects: Nausea and Vomting https://www.webmd.com/cancer/tips-for-managing-chemotherapy-side-effects Ten Tips for Surviving Chemo | Breast Cancer Support - Ready for ... https://cancerplanners.com/ten-tips-for-surviving-chemo-for-cancer-patients/ 10 Tips to Help You Through Chemotherapy – Health Essentials from ... https://health.clevelandclinic.org/2013/12/10-tips-to-help-you-through-chemotherapy/ Tips for Handling Chemo Side Effects - Side Effects - Guide2Chemo ... guide2chemo.com/tips-handling-chemo-side-effects

It can be overwhelming attending doctor appointments week after week with a plethora of information thrown at you each time, new vocabulary, new side effects to worry about, and additional risks all come flying at you at warp speed. I always came prepared to my appointments with a notepad and pen, taking copious notes, and asked for correct spellings of technical terms, knowing I would come home and Google absolutely everything! Oftentimes, our discussions in the oncology office revolved around discussing the various approaches to treating my cancer, along with weighing the benefits and risks. About one year ago, as we were discussing my surgery options, my nurse came in and handed me this pamphlet and said we should talk about Lymphedema. My head was already spinning as I was nervous about my upcoming surgery, and like a deer in headlights, I now had to worry about this potential risk. While having lymph nodes removed does not always result in developing lymphedema, it quickly became clear that this was something I would need to look out for and manage for the rest of my life; it is something that can develop immediately after surgery, or even months or even years down the road. My only real experience with lymph nodes was usually associated with when my primary care physician was checking if I had any swollen glands around my neck and to ensure I didn’t have strep throat. I was pretty clueless about the lymphatic system, how it worked, and the benefits it has on the body. What is the Lymphatic System? The Basics Our bodies have a network of lymph nodes and lymph vessels. This system collects and carries a watery, clear lymph fluid, much like how veins collect blood from distant parts of the body and carry it back to the heart. This fluid consists of proteins, salts, and water, as well as white blood cells, which help fight infection. What Causes Lymphedema Lymphedema is a chronic condition in which excess fluid collects and causes swelling, generally in the arms or legs. Lymphedema is most commonly caused by the removal of, or damage to, your lymph nodes as a part of cancer treatments. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling. According to the National Cancer Institute, anywhere from 5-17% of women who have a sentinel lymph node biopsy develop lymphedema. Among women who have axillary lymph node dissection, the percentage is higher — from 20-53% — and the risk increases with the number of nodes taken out. Not surprisingly, the risk is even higher if you receive radiation to the breast, chest, and underarm area. My Story with Lymphedema As things are shaping up, I shouldn’t be surprised that I was a prime candidate for developing lymphedema. I had an auxiliary lymph node dissection resulting in 16 lymph nodes being removed, as well as 30 rounds of radiation! Prior to my surgery, my oncological team took baseline measurements using the L-Dex machine. If you are having any lymph nodes removed, I highly recommend asking your care team about getting baseline measurements taken. This will allow you and your team to catch any changes post-surgery and catch lymphedema early if it is developing (sometimes swelling isn’t obvious to the naked eye). The procedure is painless and only takes a few minutes. It’s worth it! Lymphedema Signs and Symptoms After surgery, things seemed to be going well, and I thought I was in the clear until one day I started to notice the following symptoms: Heaviness in my arm Tingling in my fingers (that sense when your arm falls asleep) Discomfort raising my arm above 90 degrees My watch and rings no longer fit comfortably I looked down, and my hand definitely looked swollen; I was developing stage 1 of lymphedema. Below is a picture of my emerging lymphedema There are additional symptoms that I didn't experience but that patients should be aware of, including: Burning or itching sensation Skin redness Difficulty seeing veins or tendons in hands and feet Restricted range of motion Recurring infections Lymphedema Diagnosis and Treatment While lymphedema is not curable, it is manageable (phew). I took matters into my own hands and called my hospital to schedule an appointment with a lymphedema specialist. I’ve been seeing my specialist now for 4 weeks, and the improvements are profound! It was recommended that I wear a compression sleeve daily, even during my workouts, to help reduce swelling. Additionally, I do lymphatic massage (also known as manual lymph drainage [MLD]) twice a day. The lymphatic massage plays a crucial role in rerouting stagnated lymphatic fluid. The goal is to stimulate the lymph vessels and lymph nodes and to redirect the lymph flow around these blocked areas into more centrally located healthy lymph vessels and nodes. At night, I do not wear my compression sleeve, but rather, I wrap my hand to prevent swelling. While my bedtime routine is now about an additional 30 minutes to account for managing lymphedema, I have to say, my arm feels so much better, and I am confident that I will remain at stage 1 so long as I continue to take care of my skin, arm, and manage the swelling! For more information on treatment for lymphedema, please click here .

By Ashlee Duttweiler Navigating the world of healthcare is complex. I know from personal and professional experience that a diagnosis of cancer (of any kind) changes your life. Not only does it affect the cells of your body, but it also changes everything. That is why holistic care is so important, and that is one of the reasons I got involved with the Surviving Breast Cancer organization. My name is Ashlee. I met Laura at a fundraising dinner for an amazing lab making huge strides in cancer research (shout out to Dr. Whetstine and Whetstine Labs! ). As soon as she started telling me about the work she was doing in terms of breast cancer survivorship, I got super excited. Holistic health was my platform in the healthcare field, and cancer has touched family and friends surrounding me. In addition, I care a lot about supporting and advocating for patients and caregivers, which is why I am planning to pursue a career in social work. It is my desire that through my education and involvement with this amazing organization, I will be able to bring hope and light to the darkness that often goes along with health struggles. With that in mind, I’ve put together a few tips for navigating the world of healthcare that I have learned from working with doctors (professionally and personally) that will help and encourage you as you begin surviving cancer and navigating the healthcare system. 1. Advocate for Yourself (Or find someone who will do it for you) The healthcare field is overwhelming. As a patient, you have rights and are not entirely subject to what the doctor initially tells you. If you have questions, ask them and don’t stop asking until you get answers and you have a full understanding. It is usually helpful to have someone accompany you to doctor appointments or talk to insurance providers on your behalf; this person may ask questions that you might not have thought of, or help you remember all the information that is being thrown your way. Laura said she always brings a notepad and paper to all of her appointments, she takes notes, and asks for correct spellings of medicines so she can do her research once she returns home. In addition, if you do not feel like you are being treated properly or fairly, speak up! While it can be scary, you are allowed to take ownership of your care. This point is also important because sometimes it can feel like it is you (the patient and your family) against the doctors and insurance companies. Professional advocates are fairly new to the scene, but take advantage of this option! It puts someone in your corner whose sole purpose is to help you understand, check bills and information, and get you the fair treatment that you need. 2. It is OK to Get Second (or third) Opinions The more eyes that are looking at something, the better! If you don’t feel right about something or don’t like a particular doctor, it is totally fine to look elsewhere for care. There is not just one doctor who deals with your particular type of case, so if you are not satisfied, it is ok to look elsewhere. One thing that is important to remember in this case, however, is that doctors are experts in their field. My point in saying this is that they do know what they are talking about, but it is perfectly acceptable to get as many eyes on your case as you can so that you are able to make an informed decision about all of your health care options. Looking for Second or Third Opinions? Survivingbreastcancer.org has partnered with Driver (as a startup based in San Francisco), which can assist you in setting up appointments for second opinions throughout the U.S., regardless of where you are located! In addition, Driver offers several other support services, such as managing medical records, access to clinical trials, and helping our Surviving Breast Cancer community pay for these services through a GoFundMe campaign. They are donating the first $100 to your goal! Got questions on this – definitely reach out to Laura@survivingbreastcancer.org for details! 3. Do your Research There are so many great resources available specifically for you! SurvivingBreastCancer.org , for example, has a focus on survivorship from day one and beyond, but there are many organizations that will cater to your needs, whether that be financially , house cleaning, or child care, to name a few, and who want to help you through this difficult season. You are not alone! Join our Surviving Breast Cancer community. #BreastCancer #secondopinions #healthcare

Staying on track with diet, nutrition, and weight management is hard enough as it is, but to compound that with a cancer diagnosis, well, let’s just say all bets are off! I have spoken with several people, and I have received tons of emails asking the question of whether or not it is possible to lose weight after being diagnosed with breast cancer. Moreover, I hear the distress among women, myself included, who do not understand why weight gain over the years is more prevalent in those who have been diagnosed with breast cancer compared to those who have not. An interesting study from J ohns Hopkins Kimmel Cancer Center addresses some of the reasons. Going through active treatment, it’s important to get some physical exercise when you can. There were definitely days I was so fatigued I could barely walk a block. Other days, I was able to walk 10,000 steps! It was also important to nourish my body with nutrients. I rewarded myself after completing 6 months of chemotherapy with a fancy juicer, specifically the Breville Juice Fountain. I was committed to getting my health back and fueling my body with healthy fruits and veggies every morning. That, in addition to making smoothies with my Vitamix , I thought I was on track to lose the “chemo weight” and start feeling my best. Well, that was a year ago, and I haven’t lost a pound. That’s not to say it’s impossible to lose weight with a breast cancer diagnosis, but it may take a different approach. I did some research. Let me share with you what I discovered and how I am approaching diet, nutrition, and weight management now as part of my strategy for survivorship post-breast cancer! Hormonal Changes Impacting Weight Hormonal receptive breast cancer accounts for 65-75% of all breast cancer cases. If your cancer thrives in these hormonal environments, it is common to be placed on hormone therapy drugs that lower estrogen levels or block estrogen receptors altogether. It is common for women who are pre-menopausal to be placed on Tamoxifen, while post-menopausal women may be on Aromatase Inhibitors (AI) such as Anastomozole, Exemstine, or Letrozole. Though one’s menstrual cycle isn’t the only consideration taken into account. In my case, I am under 40, haven’t yet gone through menopause, and after several discussions with my oncological team, choosing the right long-term therapies for me included Letrozole plus a Lupron shot. Since starting these hormonal therapies, I have noticed I have to be extra conscious about diet and nutrition. While these therapies are saving my life from cancer, they are also throwing my body into a forced, medically induced menopausal state, where weight gain, muscle loss, and bone loss are all legitimate side effects! Because of these side effects, my care team and I are being proactive. Prior to starting these therapies, I have taken a baseline bone density test and will continue to be tested to ensure the health of my bones. Additionally, I have started to take Zometa to strengthen bones and hopefully prevent the onset of osteoporosis. Medically induced menopause abruptly alters the body by lowering hormonal levels within days or weeks, instead of gradually over several years. This drastic onset can be particularly challenging. Not only is your body changing due to breast cancer, it is also changing due to hormonal levels! After struggling with body image for some time (losing my hair, losing part of my body through surgery, and needing to rediscover my femininity, changes in body shape, size, and physical ability), I had reached a point where I wanted professional support from a nutritionist. The Weight-Loss Formula? If you have ever googled weight loss, we all know the “simple” formula that you have to burn more calories than you take in; if one pound equates to 3500 calories, in theory, by eliminating 500 calories a day, in 7 days, you would expect to have lost 1 pound. If you do this enough over time, you will lose weight. Well, that wasn’t happening for me, and I didn’t understand why. I didn’t fully understand how this “new post-diagnosis me” was functioning. While meeting with my nutritionist, uncensored and disclosing everything I eat in a day, I realized that my idea of “healthy” wasn’t adding up. The culprit: Eating all of the good healthy fats like avocado, walnuts, olives, and olive oil is great, but when you combine them all into a big salad for lunch, your salad can quickly between 700+ calories! The solution: Choose one healthy fat to add to your salad and vary it up during the week. Not only did this reduce the calories in my salad, I also started looking forward to the different salad options I was having each day! Some days there were avocado, which was a treat, and other days I got to eat delicious Kalamata olives! The culprit: Eating fish is a great way to get your omega-3 fatty acids. Not to mention it’s a great source of nutrients like vitamin D and B2, calcium, iron, potassium, zinc, and minerals! I fell in love with discovering the health benefits of fish and how my hair and skin had a new, healthy glow! However, no one ever told me to pay attention to the portion sizes! Yes, size does matter! The solution: ¼ of your plate should be dedicated to a protein source. A good measurement of this size is about the size of your fist. If it looks small, don’t worry, fill up 1/2 of your plate with delicious veggies like carrots, asparagus, Brussels sprouts, broccoli, beets, snow peas, peppers, or zucchini. The last ¼ of your plate is dedicated to starchy veggies and grains, think corn, potatoes, quinoa, and rice. Now, tell me you are still hungry after eating all of this! I was surprised how full I felt, not bloated, and I even slept better! Who knew? (My nutritionist did, and I am so glad she shared this visual with me!) I literally have it on my refrigerator to remind me every day what healthy looks like! The culprit: Red wine. As an Italian/American, how could I give up the vino? It’s common practice to have a glass or two at dinner most nights. Plus, depending on what you read, some advocate that there are health benefits of drinking red wine in moderation! Well, the more research I did, the more I discovered that wine, and specifically the sugars in wine, could actually lead to breast cancer! I was in shock! The last thing I want is a recurrence of this disease! Now, I share all of this with a grain of salt because studies have come up with conflicting evidence as to the link between alcohol and cancer. However, the bottom line – if it’s toxic and you are putting it in your body, there’s a chance it can cause harm. The solution: You can definitely choose your own path here. Personally, I know going cold turkey wasn’t going to be sustainable for me, so instead of giving up alcohol as an absolute, I’ve switched to a light beer that I have on special occasions. The verdict: It’s taken about 4 weeks, but I’m starting to notice a shift in the way my clothes fit and the way I feel. I’m focusing on the quality and quantity of my foods, getting 30 minutes of exercise in daily, and not obsessing about my post-cancer body. Instead, I’ve embraced it and thank it every day for allowing me to be alive and get back to the lifestyle I enjoy! I’m not claiming to be perfect, I’m claiming to be human! --> Interested in what my food diary looks like, take a peek here . --> Click here for some great resources on health and wellness #BreastCancer #DietandExercise #Diet #Exercise #Nutrition #hormonaltherapy #weightloss

By Amani Jambhekar, MD, MBA Between mesas which glow in the golden light, Down unpaved roads which wind out of sight. A clinic stands inside the river gorge, Where hope and healing quietly forge. He came for more insulin, his words are weary, He ran out last week but winter was dreary. His blood sugar is high, he knows the truth, He drove for hours, the road tolled his youth. He worries he can’t afford his meds, While leaders debate and turn their heads. Will he have to choose between his bills and health, In a place which doesn’t know wellness IS wealth? His physician is new, the third one this year, Another shuttered clinic - his greatest fear. He lost healthcare access in the next town, No life raft left, the less resourced will drown. All he wants is his next insulin fill, Someone to call when he’s needing a pill. Appointment wait times keep getting longer, He speaks up - they call him a fear monger. This place is the only home he knows, Where roots run deep and the red dust blows. Leaving his community would arrest his soul, But preventable death looms like an unchecked mole. He waits each month for the derm clinic to call, The phone line cuts out- there’s no service at all. He borrows and begs for the means to travel, A biopsy before his fears unravel. He now needs surgery . . . Yet another wait, Should he hope for a call or just leave the state? His footsteps falter where he once firmly stood, Should he leave New Mexico — this time for good? About the poet: Amani Jambhekar MD, MBA, FACS is a breast and melanoma surgical oncologist, writer, and photographer whose work explores the intersections of science, equity, and the human experience. Her poetry draws from the realities of the healthcare system, reflecting on access to care, bias in medicine, and the battle against misinformation. Through her artistic endeavors she amplifies overlooked voices and captures beauty in truth, resilience, and discovery.  Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

It’s Sunday Morning. The coffee is brewing, and I cuddle up on the couch to start reading the morning news. Half asleep, a little groggy, and scrolling through the media sites on my iPad, my scroll comes to an abrupt halt. A flurry of excitement washes over me as I reread the headlines of a breakthrough study literally just published this morning. Headlines from Genomic Health “Landmark TAILORx Results, Published Today in The New England Journal of Medicine, Demonstrate the Oncotype DX Breast Recurrence Score® Test Definitively Identifies the 70% of Women with Early-stage Breast Cancer Who Receive No Benefit from Chemotherapy, and the 30% of Women for Whom Chemotherapy Benefit Can be Life-saving” This news was not only published today in the New England Journal of Medicine, but was also announced and presented at the plenary session at the 2018 American Society of Clinical Oncology (ASCO). Ok, so let’s break this down a bit, and I’ll explain why this is so exciting! First, this was a much-anticipated study and has been in the works for a decade! It illustrates the important relationships and conversations between the patient and the oncologist in determining treatment post-surgery as it relates to one’s prognosis and survivorship. Medicine is not a perfect science. As much as I wanted to hear that the cancer would never return, and this was a “one and done” experience for me, it’s impossible to get a 100% guarantee. You can comb over reports, data, statistics, get second or third opinions, cry, pray, hope, you name it, but at the end of the day, it’s your decision and one you have to become comfortable with. To quote the whimsical Jerry Garcia, “Nothing is for certain, it could always go wrong”. So let the music keep playing, and we make the best decisions with the information we have at the time. But what this study found, according to Allison Kurian, an oncologist at Stanford University and quoted in the Washington Post , revealed today was that these findings “are going to change treatment — and remove uncertainty for women making decisions.” In 2018 alone, there are going to be approximately 266,000 new cases of breast cancer! Women with early-stage breast cancer, however, may no longer need chemotherapy. This applies to 85,000 women with the most common type of early-stage breast cancer who now, under consultation with their oncologist, may confidently forgo chemotherapy. What is this common early-stage breast cancer, and how is it determined? According to this study, early-stage breast cancer refers to: You’ve been diagnosed with Stage I or II breast cancer The cancer is estrogen-receptor positive The cancer has not spread to the lymph nodes If you fall into this category, your medical care team may recommend that you receive a genomic test. This test analyzes your genes to determine the behavior of the cancer and its likelihood of responding to treatment. This is done by an OncoType Dx Test . Depending on the score of your OncoType, you may be able to forego chemotherapy. Like any study, there are exceptions and outliers. As published in the Washington Post (2018) , Joseph Sparano, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Medical Center, posits that women who are 50 or younger and have received an OncoType Dx recurrence score of 16 or above got a “ substantial ” benefit from chemotherapy and should consider it. There is a lot of uncertainty involved with a breast cancer diagnosis. In some cases, you are living week to week and waiting on test results to know what happens next. There are a lot of challenging time-sensitive decisions to make and long-term stressors that bubble up like “why did this happen to me?”, or “what if it returns?”. Waking up on a Sunday morning to this news makes my day! I’ll take this positivity any time! Thank you to all of the researchers, advocates, grant writers, participants, medical care teams, caregivers, and families for moving the needle forward and advancing treatment in breast cancer! Research continues to save lives, and I am thrilled that Survivingbreastcancer.org is able to raise awareness through our blog and community outreach and be part of the movement! Additional resources on today’s topic: NPR NewYorkTimes PRNewsWire Multivu BBC #Chemotheraphy #Chemo #BreastCancer #Treatment #Ontotype

Scheduling the date of your surgery can be daunting. Depending on your treatment plan, you may have surgery before chemo, in other cases, you may have started out with neoadjuvant chemo, and you are now entering the next phase, surgery. Either way, the surgery day is going to be a great day! It is the day the doctors literally remove the cancer from your body! This mindset put me at ease, my fear subsided, and I was ready to get the cancerous tumor out of my body! There are a lot of steps leading up to surgery that I am not going to get into today (future blog post coming), like choosing your surgeons, plastic surgeons, the type of reconstruction you will have if you choose to have reconstruction.... so stay tuned. With surgery dates coming up for many in our community, I wanted to be sure to share some personal tips that I found helpful immediately following surgery. I am sharing this from personal experiences, and of course, it should not be a substitute for professional medical advice. As a reference point, I had a bilateral partial mastectomy, a full auxiliary node dissection on a Friday, I spent one night in the hospital, left with 3 drains ( see video on how to clean drains) that Saturday, and by Sunday, I met my family for brunch in South Boston and was able to walk 5 miles. (You know I wasn’t going to compromise my 10,000 step/day goal just because of a little cancer now, did you?!) What made the surgery experiment so pleasant? Here are my tips Tons of pillows! It was hard for me to sit up after lying down, so I was sleeping in almost a reclined position, as I didn’t have the chest muscle strength to get up. I splurged and got several of those pillows that are made from the beanbag material, as they conform to the body and are very comfortable. I know Bed Bath & Beyond carries them, along with Amazon, etc. These pillows were also very comfortable to prop up between my arm and my side (kind of tucked in under the armpit area), as it was very sore for me to hold my arms directly by my side. These pillows were also a God-send any time I had to get in the car and travel to the doctors. Place it between the seatbelt and your chest so that the seatbelt doesn’t irritate the surgical sites. Side note on driving The drive home from the hospital was terrible! Remind the person driving you home to drive slowly and avoid as many bumps and potholes as possible! For me at least, the bumps and fast turns exaggerated any pain I was in on day 1, leaving the hospital. Pain management I found it helpful to alternate between the oxycodone medicine the doctor prescribed and extra-strength Tylenol. Each would last about 4 hours, so I would alternate between the two every two hours so that there was overlap and I wasn’t in strong discomfort for 4 hours when one med wore out. I even set an alarm in the middle of the night, the first few nights, so that the pain wouldn’t wake me up and I could try and rest as much as possible. This process worked well for me. Over the course of a week, I was no longer on the stronger pain meds and relying on Tylenol. However, if you are still in a lot of discomfort, don’t be shy to speak with your care team about how to manage your pain. Another option that works well was the use of Ice Packs! Cold cooling compresses every 20 mins were very comforting. (A frozen bag of peas works great!) Random Materials Here’s a link to the shirts with Velcro! They were amazing! You may not be able to raise your arms over your head, and getting dressed may be difficult. Therefore, investing in zip-up shirts, button-up shirts, or Velcro makes a world of difference. I also love the below velcro shirts and aprons from Heal 'n Comfort! I used the apron to hold my drains at night while I slept, which gave me peace of mind that I wouldn't accidentally roll over onto one and have its contents splatter everywhere. They were nice and safe in the pouch! I recommend moving some of your clothes to a lower shelf in your closet so you won't have to reach high to get dressed in the morning. Same thing with the kitchen cabinets- I’m a huge coffee lover, so I wanted to be sure I could still make coffee in the mornings and reach my favorite coffee mugs. Of course, you can always ask a caregiver to reach and get things for you, but I found that preparing in this way helped me feel independent, and I’m sure it helped with my healing (i.e, I was not hopeless, I could still do some normal daily activities, which was important to me. Before you leave the hospital, ask the doctors if they can give you a second (or third) Surgical Medical Bra just to have on hand. These medical bras tend to be pretty expensive, so if the hospital can give you any extras, definitely be sure to ask! If you end up having drains, I found that looping them onto a Lanyard string while showering was the easiest for me, so the drains are not randomly hanging or tugging at the skin. Lastly, the caregiving and support from family and friends were measurable and meant a lot. Let people know if you would like visitors or not. I know it was hard for me to tell people “no,” so my caregiver played a huge role in this regard, managing when people would visit, send flowers, or be the “bad cop,” letting family and friends know they cannot visit today because I wasn’t feeling well and I needed to rest. Your body has just undergone a major trauma and needs time to heal! Honor that process and thank your body for what it is able to do! It is just over 1 year since my surgery, and I continue to be amazed by how much flexibility and mobility I have. I continue to work on my strength, and every day I’m feeling better and better. We celebrate life after cancer! For more motivation and inspiration on surviving breast cancer, follow my IG @survivingbreastcancerorg and tag us in your photos so we can see how far you have come! #breastcancer #surgery #cancer

If you ask someone who has gone through breast cancer treatment if chemo brain is a real thing, they will 100% say "yes." If you speak with some doctors about suffering from chemo brain and probe a bit deeper about long-term side effects, you may hear a different response. Some scholars think that the jury is still out on whether or not chemo brain is real. The Chemo Brain Debate Consequences from aggressive chemotherapy treatment include nausea, hot flashes, and hair loss, but why does "chemo brain" or " chemo fog " not always make the list? In this blog, we are going to address this debate and let you know how you can get involved in advancing the research on this important topic! What is Chemo Brain? According to the Mayo Clinic , chemo brain is a term used to describe the mental and cognitive challenges one experiences in day-to-day tasks. It's been described as being in a daze or heavy, cloudy fogginess. It is also described as being a very debilitating and frustrating side effect of cancer treatment. Understandably so, imagine not being able to articulate your thoughts because the word is at the tip of your tongue, but you just can't get it out. You use so much mental energy to concentrate, focus, and stay organized that it is almost impossible to muscle through a 9-5 workday without wanting to take a nap. Fatigue sets in, and short-term memory may even be compromised. Chemo Brain can last up to six months post-chemotherapy and includes symptoms such as confusion, difficulty concentrating, short attention span, short-term memory problems, difficulty with word retrieval, and difficulty learning a new skill. So, Why the Chemo Brain Debate? The University of Texas MD Anderson Cancer Center acknowledges that chemo brain is a legitimate diagnosis, and several others, including Dr. Susan Krigel, Ph.D. , agree that chemo brain is a complex and evolving science. The challenge is that researchers have only recently begun to conduct studies on the cognitive impact of chemotherapy. Prior to the 1990's there was no scientific evidence to support the anecdotal claims breast cancer patients were describing, even though 16-75% of this population was experiencing some degree of memory dysfunction. Chemo Brain Considerations Interestingly, there are so many factors that must be taken into consideration with regard to memory and brain function. According to Krigel (2015), considerations need to be made in terms of age, genetic predisposition, baseline cognitive performance, diet, and hormonal levels, to name a few. As you can see: "More research is needed so that we can obtain a better understanding of the short-term and long-term impact of chemotherapy on memory and cognitive performance among those who have been diagnosed with breast cancer." How to Help Advance Chemo Brain Research Since 2004, the lab at the University of Colorado Denver (UCD) has been studying the effects of cancer chemotherapy on the brain and on cognitive abilities such as memory and concentration. As you may know firsthand or from others, chemo brain can have significant negative effects on quality of life, but we still don't really understand what causes it, and more importantly, we do not know how to treat and prevent it. Susanne Withrow from UCD is looking to learn more about the factors that are associated with the experience of chemo brain symptoms. Breast Cancer Treatment and Chemo Brain Withrow and her lab are studying the effects of breast cancer treatments on cognitive functioning among women with and without a history of breast cancer between the ages of 35 and 85 years. If you would like, you may choose to voluntarily participate in the anonymous 20-30 minute survey, which focuses on background information, memory, concentration, and mood. The research has been approved by the Colorado Multiple Institutional Review Board (COMIRB, Protocol 15-1509), which is responsible for approving the adherence to ethical standards of all human subjects research conducted at the University of Colorado Denver. Click Here to take the survey now. If you have questions about this study, please feel free to contact Susanne Withrow directly. Thank you from the SBC team and helping us advance research! Xo

By Taylor McKnight Finishing your breast cancer treatment is an exciting moment. When you first faced your diagnosis, you might not have been able to imagine reaching this point. Now, you have the opportunity to reclaim and/or redefine certain aspects of the path ahead. As you begin the next phase of your care, here are seven steps to prioritize your health as a cancer survivor. Learn How to Cope With Uncertainty You’ve undoubtedly faced lots of uncertainty over the course of your treatment. While you might have once envisioned this moment as bringing you total relief, the truth is that most cancer survivors face continued uncertainty. The good news is that you’ve reached a major milestone by completing treatment. Still, it’s normal to worry about the cancer coming back or developing a new health issue. As best you can, try to focus on enjoying the present. You can’t stop everything difficult that happens in life, but you can maximize how you use your precious time. Rely On Advice From Your Care Team You may be wishing you’ll never see the inside of a medical facility again. The truth is, many breast cancer survivors need to continue with periodic testing and exams. You might also need to undergo physical therapy  and other treatments to restore your mobility and overall health after cancer treatment. Make sure to follow all of the details outlined in your maintenance plan. Taking your medications and continuing with recommended screenings will help you maintain your health. Develop a New Routine After spending so much time in treatment, you might feel a bit lost looking ahead at a blank schedule. You may also need to adjust to changes in your medication regimen and other aspects of your daily routine. Take your time to ease into a new routine with plenty of time to eat healthy meals , rest, and enjoy gentle movement. Finding new hobbies can also help you address the physical and mental changes you may be experiencing during this time. Revive Your Support Network When you first received your diagnosis, you might have discovered that family and friends rallied around you to offer support. By now, some people from your support network may have dropped off. Or, people may not know what types of support you need once you’ve finished treatment. During survivorship, you might still need people to talk to about your anxiety. If you have lingering fatigue  and mobility challenges, you may still need assistance with meal prep, driving and other daily activities. Reviving your support network now paves the way for an easier future. Use a Medical Alert Device One of the best parts of cancer survivorship is regaining many aspects of your independence. While you might not be confined to a bed or the cancer treatment center, you will need to be careful as you regain your strength . Medical alert devices for cancer survivors help you strike the perfect balance between being independent and having someone monitor your well-being. If you experience dizziness and fall, you can use a medical alert device to ensure that an alert will be sent that you need assistance. Take Care of Your Mental Health Going through cancer can be traumatic. Talking to a professional therapist can help you work through your trauma and identify any underlying conditions that impact your overall mental health. Depression, anxiety and PTSD  are all treatable conditions that you can address to improve your outlook moving forward. Address Lingering Side Effects Some people experience side effects even after treatment is over. For now, you may need to use medication to overcome nausea to ensure you get good nutrition. You might also need to work on your balance, strength and cardiovascular health  as you continue the process of healing. Finding ways to address your lingering symptoms allows you to feel your best each day. Everyone’s cancer experience is different, and being able to work toward  better health is an essential goal. As your body continues working on its recovery, make sure to give yourself the support you need . Finding ways to live safely with greater independence while also knowing when to reach out for support allows you to get the most out of survivorship. By Taylor McKnight, Author for SureSafe Read More: What is Breast Cancer Rehab? Managing Fatigue During Breast Cancer Treatment: Tips for Conserving Energy Breast Cancer and Mental Health: Recognizing and Addressing Depression and Anxiety Breast Cancer and Heart Health: The Connection You Need to Know About The Role of Nutrition in Breast Cancer Recovery: Optimizing Your Diet for Healing On the Podcast: Breast Cancer Conversations Beyond One and Done: The Realities of Surgery and Reconstruction Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

What are you reading these days? If you are an avid reader, you probably have a running list of your must read books already cued up. However, if you have been diagnosed with breast cancer or recently found out that you carry the BRCA gene, your reading list may have turned into scouring the internet for answers, reading cancer blogs, medical journals, and the like. The search for information can be overwhelming, perhaps generating more questions then answers, and leaving you feeling lost and alone. When I was diagnosed with breast cancer at 34, this was my reality. At Survivingbreastcancer.org we are pleased to be able to offer our readers content drawn from real experiences and further disseminate resources and information because we all know "Knowledge is Power". Today on the Blog, if you are looking for a good read from someone who has been there - this is what you've been waiting for! Understanding BRCA: Living With The Breast Cancer Gene by Clarissa Foster BRCA (pronounced ‘bracka’) stands for Breast Cancer susceptibility gene. There are two BRCA genes – BRCA1 and BRCA2. These genes function as tumor suppressors, helping to prevent the formation of cancer. When either of these genes carries a mutation, a woman has a high risk of developing breast and ovarian cancer, and men with these mutations are also at increased risk of breast and prostate cancer. Mutations in these genes have also been associated with a small increased risk of several additional types of cancer. At the age of 35, I was found to carry a harmful mutation in the second breast cancer (BRCA2) gene and statistics suggested that I had a 45-85% chance of developing breast cancer and a 10-30% risk of developing ovarian cancer during my lifetime, which is much higher than in the general population. Finding out that you carry a BRCA mutation is hard, and if this happens to you, you will have a great many questions that you will feel desperate to find the answers to. I felt overwhelmed and scared of the future that lay ahead. I desperately wanted to connect with other women who were going through the same thing as me and to find answers to my many questions. I looked for a BRCA support group locally, but there were none. I also looked for a book but none seemed to offer what I was looking for. I was eager to meet with the consultants that I had been referred to, but this process takes time and it was frustrating waiting for these appointments. I hoped they would be able to answer all of my questions but, in reality, even the consultants didn’t have all the answers as we do not yet fully understand the BRCA genes and their impact. I felt very frightened, alone and frustrated that there seemed to be so little help and support and I wanted this to change. I decided, therefore, that once I had come through my own journey, I would write a book with the aim of helping others. This book aims to improve your understanding of BRCA gene mutations and the various ways in which a carrier can manage his/her mutation, including screening, risk-reducing surgery and chemo-prevention, with reference to relevant research. In the last part of this book, I share with you my own personal journey of undergoing risk-reducing surgery, including the removal of my ovaries and fallopian tubes (known as a bilateral salpingo-oophorectomy, pronounced oo-for-ek-tuh-mee) and the removal of my breast tissue while retaining my nipples (known as a bilateral, nipple-sparing mastectomy). I detail, openly and honestly, the emotions I felt before, during and after my surgeries, along with the physical experience of undergoing these operations and the surgically-induced menopause which follows the removal of both ovaries. I will share the effect, if any, that these operations have had on my body image, identity and sexual functioning. This book aims to answer the many questions that I personally had, including those that you may feel are simply too uncomfortable to ask. I felt anxious about so many things but, having come through my own journey, I realize now that I needn’t have worried anywhere near as much as I did. I really wish I had known then what I know now; it would have spared me a lot of fear and anxiety. If you have been found to carry a BRCA gene mutation, I hope that by sharing my journey with you, you will see for yourself that this journey, albeit very tough, may not be as terrifying and as insurmountable as you may be feeling right now. You will get through this – I did and you can too. And, while I appreciate you may not be feeling this way now, you may even be nicely surprised by the positive ways in which this journey may change you as a person. I am an Advanced-level Human Biology teacher and have experience of teaching both GCSE and Advanced-level (A-level) Human Biology. I also have experience of medical writing and have drawn from both of these skills throughout the writing of this book. My desire to help others has inspired me not only to write this book, but also to set up a website to offer my support to women and men worldwide who have been found to carry, or who believe they may carry, a BRCA1 or BRCA2 gene mutation. This blog was taken from Clarissa Foster’s new book Understanding BRCA: Living with the breast cancer gene is now available on the Hammersmith Health Books website. #BRCA #breastcancer #BRCA1 #BRCA2

Where We’ve Been Survivingbreastcancer.org kicked off breast cancer awareness month in historic Philadelphia. It was the first time we were exhibiting at the Living Beyond Breast Cancer conference, and we cannot wait to return next year. We met amazing men and women, attended sessions to learn about the newest treatments and latest research, and had some deep dive conversations about yoga, meditation, and the power of writing to heal. With our focus on health and wellness, it was no surprise we became fast friends with several organizations that are helping those diagnosed with breast cancer (check out Wellness Warriors , 2Unstoppable , and Casting for Recovery, to name a few). One of the highlights from the conference was meeting Charlotte Matthews, a breast cancer survivor, poet, and faculty member who runs workshops to illustrate the power of writing as a tool to help those diagnosed with cancer by sharing their stories. I highly recommend checking out her latest publication, Truth: Voices of Women Changed by Cancer , and our exclusive interview with the woman behind the typewriter. Thanks to RedSparks Films, the trailer below launches Matthew's project based on one of her poems about her diagnosis with stage 3 breast cancer at the age of 39. A powerful conversation arose when speaking with a woman about breast cancer, and the number of times we said “if only I had known” or “I wish I knew that ahead of time”. This sparked our interest as the organization StoreMyTumor ,   which offers a private option to those who want to preserve their live tumor cells! This enables you to go back to your original tumor and have access to the information in the event you need genetic sequencing or customized vaccines. Personally, I did not know about this option at the time of my diagnosis. In fact, when I found out I had breast cancer, it never occurred to me what happens to my tumor (tissue) once they remove it. Feel empowered and ask your medical care team what happens to the tumor post-biopsy or post-surgery? It’s important to know where your tissue goes and how it is utilized, after all, it is yours! On the Road Again What started off as a small get-together in the Boston area with survivors, caregivers, and friends has quickly become one of our Signature programs. Our Survivors and Friends Meet and Greets. While the name of the program is consistent, each city we visit takes on its unique personality! In Philadelphia, we hosted a Sunday Brunch. We were thrilled to have medical oncologists and researchers from Temple attend, as well as collaborators from the Philadelphia/Wilmington FB group partner with us to host a celebratory brunch. Highlights include survivor stories and meeting the face behind the blog BeautyThroughTheBeast , Chiara! Next Stop: Chicago There is no better way to say “Cancer didn’t win” than by checking off a bucket-list item, running a marathon! Yes, going to the infusion center week after week, daily rounds of radiation, or the hours of bed rest recovering from surgery certainly have similar qualities to a marathon, but the joy (and pain) one endures in putting in the long hours of training and completing a marathon is like no other! And that’s exactly what these breast cancer thrivers did! An open house was held for our Chicago-based breast cancer Survivors and Friends meet and greet in the home I grew up in. We were honored to have women from all over the Chicagoland area attend, donate, and exhibit their breast cancer products (Thank you, Medical ID Fashions and Complete Shaping ). Additionally, we got to connect with amazing women like Maira Luisa, who is the founder of Courage for the Sou l, which provides scarves to those who are undergoing chemotherapy. The next morning, these brave souls were off to run 26.2 miles and celebrate life one step after the other! Special shout-out to Nicole Mancini (BC Survivor), who never left my side the entire race, ensuring that as we started together, we would finish together! Talk about a fabulous teammate! Cancer didn’t know who it was up against, that’s for sure! Finally, the energy in Chicago continues to be vibrant. After I had left town, I was thrilled to see the Chicago community gather for the release of Ginger the Movie Back to Beantown: Taking a Look at Breast Cancer Disparities We know that breast cancer is pervasive, but did you know that black women are 43% more likely to die of breast cancer than white women, according to the Breast Cancer Research Foundation . Other disparities include those who identify as LGBTQ. While more research is needed, according to the Young Survival Coalition, this population tends to engage in more breast cancer risk behaviors such as smoking, alcohol consumption, and obesity. Continuing to press the conversation forward, have you ever considered the role culture plays in a breast cancer diagnosis? What if English was not your first language? Do you have access to translators to explain to you your pathology report? Would your culture be accepting of your diagnosis or is it something you keep close to the vest and never talk about? How does a culture, gender, race, identity and a diagnosis impact cultural norms and expectations? A blog specifically on these topics is forthcoming as it cannot be summarized or taken lightly. Themes include selfishness, divorce, lack of support, depression, anxiety, fear of finding out you have cancer so better to not get screened. Here are highlights from two powerful events this October, the Audre Lorde Brunch , and the Asian Women for Health Fashion Show (CelebrASIANS): SurvivingBreastCancer.Orgs’ Survivors and Friends Meet and Greet Half meet and greet, half speaker’s bureau, half fundraising, half building local community support, I don’t actually have a name for what we did, but all I can say is that it was a huge success and give thanks to our sponsors at Benchmark Independent Living for hosting us! We heard survivor stories, information from plant-based advocate, Abby Power, and were led on a guided meditation and introduced to “Laughing Yoga” from Soul-Re-engineering’s Claudia Gallo. The next day, we gave thanks to mother earth and sang and chanted in the Lakota native American language because the universe is powerful and we want to stay in its positive grace. Between Paint Night at Tufts Medical Center and wonderful conversations with community members, we concluded breast cancer awareness month with a fundraiser at Club Pilates at Assembly Row . Building strength, toning and stretching are great exercises post-surgery and can help prevent lymphedema if you had your lymph nodes removed. It was a fun day raising awareness and being grateful for what our bodies CAN do! Where We Are Heading If you’ve gotten this far I’m thrilled because you will definitely love where we are going next and how you can get involved and join our community! Here’s a sneak peak of things to come for 2019: Survivors and Friends Meet and Greets are heading to Atlanta! Stay tuned for dates and details. (More locations coming soon!) Survivingbreastcancer.org will be launching our podcasts where we share survivor stories, meet with leading medical professionals, share inspirational meditations, affirmations, and tools for assisting the caregivers, plus more! Interested in being a guest on our PodCast, we’d love to hear from you. Contact William to schedule time for us to connect. While we love our 1 day meet and greets, the power of our community needs more than just a few hours. Stay tuned as we plan our first Survivingbreastcancer.org Retreats! Looking for something in particular? Let us know, these retreats are for YOU! ***Click Here*** Complete a quick survey so we can be sure to meet the needs of our community members. Thank you to everyone who believes in our mission! We were energized by what October has brought us. We will be strategizing, reflecting, and reenergizing during the upcoming holiday season and cannot wait to hit the road again in 2019! If you haven’t done so already PLEASE show your love by subscribing to our YouTube Channel and follow us on Instagram @survivingbreastcancerorg XO, The SBC Team

We, at survivingbreastcancer.org , continuously seek ways to provide health and wellness activities for those diagnosed with breast cancer and today we turn to an organization providing so much camaraderie and wellbeing to the breast cancer community, the Wellness Warriors. The Wellness Warriors support those who have been diagnosed with any type of cancer, though approximately 50% of their members are those who have been diagnosed with breast cancer. We were most fortunate to share exhibit space with the Wellness Warriors of Boston at the 2018 CelebrASIANS Benefit Fashion Show (benefiting the Boston Asian Breast Cancer Community ) in Boston and then they graciously hosted an exhibit table at our Greater Boston Breast Cancer Awareness Event . Needless to say we were inspired by their mission, contribution to the Breast Cancer Community, their sense of adventure, fun and accomplishment. Before we jump into what their organization is all about, I want to provide some brief background. For anyone who has had their lymph nodes removed, developing lymphedema is a real concern (See our blog on Lymphedema ). A shocking statistic reads that 30% of those who have had their lymph nodes removed will develop lymphedema during their lifetime. While it has been argued that repetitive motion could be a cause of developing this non reversible side effect, a group of researches set out to do a study and investigate if an activity such as dragon boat racing would help those diagnosed with breast cancer, get moving, exercise, and use their upper bodies to build strength and increase mobility. In a case study out of the University of British Columbia, the findings were one of the first to "provide quantitative evidence suggesting that dragon boat racing and other vigorous upper-body exercise are actually safe activities" (Harris, S.R., et al. J Surg Oncol. 2000 Jun; 74(2):95-8). Without further adieu we have raided their website (with their permissions of course) to present their Mission, and the reason you may wish to reach out to them to join their community. We are all in this together as we seek to improve the lives of those diagnosed with breast cancer, as well as their caregivers and support team. We are also looking to do a podcast with this terrific group soon. What Follows are excepts from the Wellness Warriors Website: Wellness Warriors of Boston https://wellnesswarriorsboston.org Our Mission Our mission is to provide new opportunities for cancer survivors to heal – both physically and emotionally – by being active participants in their own recovery and part of a mutually empowering dragon boat team. In addition, we are working to raise awareness within the metropolitan Boston survivor and medical professional community of the benefits of paddling for cancer recovery, wellness, and a healthy lifestyle. We accomplish this through education, outreach, and by being an inspirational presence of strong and confident cancer survivors. “Dragon boating has helped me make friends with my body again after the punishing effects of cancer treatment. The Wellness Warriors have helped me figure out who I am post treatment.” Who We Are Some of us are receiving chemotherapy, radiation and other cancer-fighting strategies, while others have completed treatments, but are still working through the cancer experience. For others still, cancer is a distant memory. We are a diverse group committed to dragon boating as part of our self-care after cancer diagnosis. Why We Paddle On or off the boat we are united as a team. We support and encourage each other. Not only is dragon boat paddling good for our health, it’s a lot of fun. We are excited each week to join our friends on this paddling journey being coached by our intrepid leader, Coach Peter. He teaches that by working together, nothing is impossible. When we’re tired, we can keep going. We all work together to tap our inner reserves and come off the water feeling stronger. We cherish the views from the middle of the Charles River. What a spectacular place to see the setting sun reflected on the river and buildings of the Boston skyline. We love the warm temperatures, longer daylight hours, and the evening breezes. Even the river is warm. In the early summer, ducks and geese drift by with their babies in tow, and an occasional fish jumps high in the water. We savor our accomplishments – learning to paddle better, harder or faster. Our experiences on dragon boats help make us stronger. We appreciate the support and encouragement of other dragon boat teams. In the summer months, we have friendship races up and down the river to practice our starts and build our endurance. Nothing cheers us on more than a “Great race!” from a competing team. We relish the exhilaration of flying across the water when we paddle in sync with each other. Coach Peter’s “You’re doing well” is music to us all. We treasure the sense of being alive, using our muscles and building our strength. No matter where we are on the cancer journey or in our athletic ability, our rise to the physical challenges of dragon boat paddling makes us a team of thrivers. Each time we are on the water, we are reminded that we are vital and alive, and we become aware of the rewards of teamwork and personal accomplishment. Please join us on this adventure of wellness. Your Wellness Warriors teammates will support you in living the best life possible after cancer. We are grateful to family and friends who give us this time and are there to support us — not just at dragon boat competitions — but every day, rain or shine. We paddle for other cancer survivors and caregivers to pass on the HOPE that has been given to us. We want to show them there is a lot they can do, even as they work through their own cancer experience. If you feel that this activity suits your fancy, please feel free to visit their website and say we @survivingbreastcancerorg highly recommend them! Sending Hugs, The SBC Team

Guest Blogger, Katerina Gmitter, Founder of EcoThriver.com How green and clean is your cleaning routine? Did you know that conventional cleaners can introduce hundreds of chemicals into your home? Did you know that there is no FDA approval needed for many of the chemicals in cleaning products? Due to trade secrets, companies do not need to disclose their full ingredient list. This allows hundreds of chemical compounds to be included in one ingredient, fragrance, or parfum. Why Does Green Cleaning Matter? Many cleaning supplies and household products can cause irritation of the skin, eyes, or throat, cause headaches, cancer, and other health problems. Many products contain volatile organic compounds that are harmful when inhaled. This includes air fresheners, fabric softeners, scented laundry detergent, ammonia, and bleach (found in many cleaners, including dishwashing detergents). Did you know there are ingredients used in the U.S. that are banned in European countries due to their toxicity? The Benefits of Going Green with Cleaning This January, I celebrate 9 years of cancer survivorship! When our family first decided to go “eco” and “nontoxic,” I was beyond overwhelmed. I just finished treatment, including a double mastectomy and 6 months of chemotherapy. I met with a nutritionist (helpful) and a cancer survivorship “guru” (not helpful) who literally was on my living room floor simulating how to give myself a coffee enema. That is when I delved into my own research on how to eliminate household toxins, live a cleaner and greener life, reduce my personal risk of recurrence, and raise healthier kids. By going green with your cleaning routine, you are improving your indoor air quality, your health, your lungs, and your energy. Toxins from conventional cleaners (like formaldehyde) get into the air, sit on surfaces (including glassware and dishes), and are absorbed through your skin. Cleaning was actually one of the later healthy changes we made because I felt it was so overwhelming to decide what to choose. Avoiding Toxic Cleaning Products I grew up with conventional store-bought cleaners, and their smell told my brain the house was clean. My brain used to recognize the smell of bleach, Windex, and Pledge as “clean." Now my brain recognizes that clean doesn’t have a scent, and if it does, it is a lingering vinegar scent or the scent of fresh lemons. How do you start greening your cleaners? Terms like “natural” and “safe” are overused, and greenwashing is a large problem. Here are some steps to follow: Read ingredients; if ingredients aren’t listed, do not buy it! Products claim to be safe and natural, and they just aren’t. Cleaners fall into 3 categories: worst, better, and best. You can use this guide to help you make educated choices . Avoid fragrance in all your cleaning products (all products really!) If you really want a smell to your products, you can add some lemon essential oil, lavender, or grapefruit. You can make your own cleaners! Here is a great resource: https://www.womensvoices.org/take-action-with-womens-voices/green-cleaning-parties/green-cleaning-recipes/ . Had I known how easy it was to make my own products, I would have started sooner! My Green Cleaning Arsenal includes white distilled vinegar, peroxide, washing soda, and castile soap. I make a fantastic dishwasher detergent and laundry detergent! Vinegar and water are used to clean my floors, counters, and more. I have started teaching eco-cleaning classes as well! Empowering other women to live a cleaner and greener life is my passion. The past 9 years of survivorship have brought out the best and worst of life. I have learned that healing is not linear and that small changes can have a large impact. Here's to making at least one small change that may lead to more! Happy clean and green cleaning! Resources: https://www.cbsnews.com/pictures/ewgs-hall-of-shame-of-toxic-household-cleaners/ https://www.lung.org/our-initiatives/healthy-air/indoor/indoor-air-pollutants/cleaning-supplies-household-chem.html https://www.sciencenews.org/article/household-products-make-surprisingly-large-contributions-air-pollution #survivingbreastcancer #breastcancer #eco #ecofriendly #greencleaning #cleaningsupplies #nontoxic

By Dr. Paula Gordon Canadian women should be outraged. The Canadian Task Force on Preventive Health (CTF) released its latest guidelines for screening for breast cancer in women at average risk. They advise against mammography for women aged 40-49, against women doing breast self-examination (BSE), and against doctors doing breast exams. They recommend women aged 50-74 have mammograms every 2-3 years. What the CTF Gets Wrong About Screening A 2014 study of screening in Canada showed 40% fewer deaths among women who had screening mammograms than women who didn’t, but the CTF deliberately chose to ignore observational studies done with modern mammography equipment, in favour of Randomized Control Trials (RCTs) from the 1960s to 1990s, which show only a 15-20% mortality reduction. The only measurable outcome of an RCT is how many women die of breast cancer, so the CTF ignores three other significant benefits of early detection of cancer: the ability to avoid mastectomy, lymphedema, and chemotherapy. How can the CTF not recommend annual mammography starting at age 40, if it saves the most lives, and allows more women to have less aggressive treatment? The answer is they focus on “harms”: the number of women who are recalled for additional tests after screening, and “overdiagnosis.” False-Positives and Overdiagnosis About 10% of women need additional tests after screening. The CTF uses the pejorative term, “false positive.” That term implies that a cancer was diagnosed, when none was present. This is not the case: women are recalled when there is a potential cancer. This causes anxiety for many women, but it’s transient, and studies show that it doesn’t harm women long-term . The CTF gives undue weight to overdiagnosis in the harms-to-benefit discussion. Overdiagnosis is the theoretical possibility that a woman will be diagnosed with breast cancer and treated for it, but die of something else (like a heart attack) before she would have died of cancer. The rate of overdiagnosis can only be estimated. Experts estimate it at 10% or less. The CTF says that most women aged 40-49 would choose not to be screened. From my thousands of conversations with women during my career and in published research , when told that mammograms can prevent breast cancer death, and allow them to have a lumpectomy and avoid chemotherapy if cancer is detected early, most women choose to be screened. The Importance of Additional Screening for Dense Breasts The CTF calls breast density an emerging issue. We’ve known about it for 40 years ! Having dense breasts is a higher risk than having a mother or sister with breast cancer. Mammography is 96% sensitive in fatty breasts but only about 50% sensitive in the densest breasts. And when cancers go undetected by mammography, they grow larger and can spread by the time they are found. The CTF has not acknowledged the harm of not offering supplementary screening for women with dense breasts. The CTF says there’s insufficient evidence to recommend supplementary screening for women with dense breasts because of their insistence on RCTs. An RCT of screening ultrasound is underway in Japan, but it will take at least 7-10 years before it can prove mortality reduction. We have observational data from multiple studies showing that ultrasound finds an additional 3-4 cancers per thousand women . Finding these cancers earlier will allow less aggressive treatment AND reduce mortality. With convincing observational data available, women shouldn’t have to keep dying prematurely until the Japanese RCT is complete. CTF Screening Philosophy Issues The CTF exaggerates the “harms” of screening, but they don’t mention the harms of not screening. Yaffe calculated, using a model based on CISNET , that in Canada, approximately 4,000 more women can be expected to die of breast cancer in the next decade, if the CTF guidelines are followed, rather than starting screening at age 40. The CTF refuses to consider evidence other than RCTs. The Canadian taxpayer is funding this misadventure that will lead to loss of life and unnecessary suffering for women who develop breast cancer and are denied early diagnoses when cancers are small, confined to the breast, and most successfully treated. Annual mammographic screening starting at age 40 saves the most lives , albeit with the inconvenience and stress of recalls and the theoretical possibility of overdiagnosis. Supplementary screening for women with dense breasts can detect early cancers missed on mammography, saving more lives. All women and their family doctors deserve to have all the facts and the option of shared decision-making, to decide whether the harms outweigh the real benefits. Instead of protecting women from screening, it’s time to start saving women’s lives.

Published by Sponsor Store My Tumor Only by recognizing that each patient is different can oncologists begin to design tailored and effective treatments, but this requires the patient’s tumors (cancer cells and tissue) to be preserved alive. StoreMyTumor helps patients collect, process, and preserve their tumors alive (for all indications). How Storing Tumors Helps Patients FACT: Two people with the exact same cancer diagnosis can and do respond differently to the exact same treatment regimens. Each person is unique, and so is their cancer. FACT: Up to 50% of cancer patients do not respond to traditional treatments and are forced to explore advanced diagnostics and personalized treatments that require your tumor. FACT: When you match the RIGHT targeted therapy or chemotherapy to the RIGHT tumor, tumors can shrink, and hopefully the cancer goes into remission or at least remains stable. FACT: A new class of treatments called Immunotherapy (cancer vaccines) awakens and stimulates your immune system to actively fight the cancer cells with and without toxic side effects. FACT: To potentially benefit from personalized treatment options, you need tissue from your specific tumor. This tumor tissue can only be collected at the time of biopsy or surgery. StoreMyTumor preserves patients’ tumors in multiple formats so that the preserved tumor is compliant with most advanced diagnostics and treatments. The Process StoreMyTumor can work with any hospital or cancer center. The patient seeks this service before the surgery. StoreMyTumor obtains the patient’s consent and sends the patient a collection kit with detailed instructions for the surgeon. Once the tumor is packed and the kit is received back, StoreMyTumor processes the tumor and preserves it. Patients then work with their oncologist and StoreMyTumor and instruct StoreMyTumor to coordinate parts of the tumor sent for diagnostics and parts for immunotherapy, thus allowing them to maximize their potential therapeutic and diagnostic options. What is a Preserved Tumor Used For? Advanced Testing: The tumor is tested to identify the drug or combination that will work and rule out drugs that will not. This is important to identify the ideal drug cocktail from day one, as opposed to trying to learn. Personalized Immunotherapy: Tumor is used in preparing cellular immunotherapies that awaken and stimulate the immune system to fight the cancer. There are different types of immune-therapies, including Vaccines and T-cell therapy. Bottom Line Patients must make this decision before the biopsy or surgery, or ascites drainage. Every tumor is unique and contains information critical to treatment, but tumors are not preserved in the right formats by the hospital and are routinely discarded as medical waste. As the disease advances, standardized treatments are often not enough. Having the tumor preserved is the only way to test it and use it to create more customized treatments and strategies that are more likely to work. It is a process, and this is personalized medicine at its best. StoreMyTumor is the trusted tumor preservation service leader for cutting-edge cancer centers worldwide. Team StoreMyTumor +1.267.702.5501 cs@storemytumor.com www.StoreMyTumor.com

Sponsored by Store My Tumor Written by Robyn Stoller Today, most people with cancer receive a one-size-fits-all approach to treatment, meaning they receive the same treatment as others who have the same type and stage of cancer. However, research has now shown that each person’s cancer is unique, and each tumor may contain information critical to treating that cancer. Although still in its infancy, precision medicine is beginning to change the way cancer is treated. Here are 5 facts you need to know about precision medicine and cancer: 1. Precision Medicine Helps to Personalize Cancer Treatments The National Institute of Cancer defines precision medicine (also known as personalized medicine) as “an approach to patient care that allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease.” [1] 2. No Two Cancers are Exactly Alike We now know that just as no two people are exactly alike, no two cancers are alike. Using this knowledge, precision medicine aims to treat cancer by targeting mutations that allow cancer to grow and spread. To identify those mutations or genetic changes that drive a particular person’s cancer, we test DNA from their tumor(s). This is known as “molecular profiling” and “genetic sequencing”. This testing may also help patients avoid treatments that are ineffective, unnecessary, and potentially harmful. 3. Precision Medicine is Transforming the Way Some Cancers are Treated TODAY Several cancers are already benefiting from precision medicine treatments . Today, oncologists can prescribe targeted therapies to cancer patients whose tumors have certain genetic mutations. For example, Trastuzumab (Herceptin®) or lapatinib (TYKERB®) may be given to a woman whose lab tests show that her breast tumor has too much HER2. Everolimus (Afinitor) may be used for women who have gone through menopause and have advanced hormone receptor-positive, HER2-negative breast cancer. As a result, patients are experiencing better outcomes with fewer adverse effects compared to standard chemotherapy. Please note: At this time, not all mutations can be matched with known treatment options. 4. Immunotherapy is Already Helping to Save Lives One of the most promising areas in cancer research and precision medicine today is “ Immunotherapy , “ which uses the body’s own immune system to prevent, control, and eliminate cancer. Credited as the first therapy ever proven to extend the lives of patients with metastatic melanoma, immunotherapy is changing the way some cancers are treated today. In fact, immunotherapy offers such great promise that one day we may have a new kind of doctor called an immuno-oncologist. 5. StoreMyTumor is the First Step to Personalized Medicine Your tumors contain critical information needed to personalize your cancer treatments. When live cancer cells and tissue are stored properly , additional and more effective cancer treatment options may become available to you. Personalization is a process. It starts with having access to the cancer cells, then testing the tumor to identify the best drug(s) that will kill cancer cells. StoreMyTumor , the leader in tumor collection, processing, and storage services, connects you to cutting-edge technologies that are beyond standard treatments. To learn more about personalizing your cancer treatment, schedule your FREE consultation today with our Patient Advisor! [1] https://www.cancer.gov/about-cancer/treatment/types/precision-medicine

Jan. 21, 2019| By Diane Mapes / Fred Hutch News Service Original article published on FredHutch.org here . Study reveals how blood vessels in the bone marrow protect dormant tumor cells, suggests a way to kill them in their sleep. Fred Hutch translational researcher Dr. Cyrus Ghajar talks about the spread of breast cancer tumor cells during the third annual Northwest Metastatic Breast Cancer Conference in October 2018. Video excerpt by Connor O'Shaughnessy / Fred Hutch News Service Researchers at Fred Hutchinson Cancer Research Center in Seattle may have found a way to essentially smother cancer cells in their sleep, preventing them from ever waking up and forming deadly metastatic tumors. Fred Hutch translational researcher Dr. Cyrus Ghajar Photo by Robert Hood / Fred Hutch News Service The work, led by translational researcher Dr. Cyrus Ghajar , has also turned on its ear the longstanding belief that chemotherapy can’t kill dormant disseminated tumor cells — cancer cells that escape early on and hide out in other regions of the body — because those cells are in a “sleeper state.” They’ve stopped growing, so chemo, which blindly targets all fast-growing cells, healthy and otherwise, doesn’t work. That’s not quite the case. “It’s always been assumed that dormant cells cannot be killed by any kind of chemotherapy because they’re not dividing,” said Ghajar, who runs the Laboratory for the Study of Metastatic Microenvironments at Fred Hutch. “But what we’re showing is that’s not true. They’re relying on survival signaling in their microenvironment, in this case specifically from blood vessels within the bone marrow. And if you can take away that signaling, you can sensitize them to chemotherapy.” Ghajar’s paper, published today in Nature Cell Biology , is the culmination of more than four years’ work and proposes both a paradigm shift in how we view dormant disseminated tumor cells — and a new therapy to potentially slay this sleeping giant. Although it’s still early days, Ghajar and his team slashed the metastatic relapse rate in his mice by more than two-thirds. Rebecca Seago-Coyle, a 43-year-old IT project manager and breast cancer survivor who worked with the team as a research advocate, said she loved Ghajar’s innovative approach — and his inclusiveness. “One thing I love about Cyrus is that he makes room for patients,” she said. “We always have a seat at the table. I’m not metastatic, but I still have that fear that the cancer could come back. Thirty percent of early stagers go on to become metastatic. If we could lower that number, that would be huge.” The Nonlinear Path to Metastasis Cancer doesn’t just spread because a primary tumor has reached a certain size or stage. Disseminated tumor cells, or DTCs, can break off before a tumor has even formed and travel to distant sites in the body where they lie dormant until something “wakes them up” and they start the deadly process of metastasis, or cancer spread/colonization. One common hideout for these sleepy creeps is the bone marrow. Dormant tumor cells have been found in the bone marrow of breast cancer patients at the very earliest stage of the disease — DCIS or stage 0 — and Ghajar said they’re most likely present in other patients with early-stage disease, as well. Past research has shown an association between DTCs in the bone marrow of cancer patients and metastatic recurrence, and not necessarily just bone metastasis. “Patients with breast cancer cells in the marrow recur more often than patients who don’t have cells in the bone marrow,” said Ghajar, who collaborated with a cadre of Fred Hutch researchers as well as scientists from the University of Colorado Anschutz Medical Campus and the University of California, San Diego. “And tumor cells in the bone marrow predict metastasis in a variety of different sites. They even predict metastasis in cancers that never get bone mets.” Why disseminated tumor cells snuggle up to the bone marrow microenvironment, where they go dormant, is still a bit of a mystery, although we do know that dormant blood stem cells hang out in the same place. What wakes the sleeping cancer cells up and starts them growing again also remains a huge question. But Ghajar said there’s scientific evidence that “if you can successfully remove disseminated tumor cells, you can prevent those patients from having mets.” And that has become the focus of his work. Fred Hutch's Dr. Cyrus Ghajar with breast cancer patient research advocates Teri Pollastro (left) and Rebecca Seago-Coyle. Photo courtesy of Diane Mapes Breast Cancer’s ‘Long Tail’ For this research, Ghajar and his team focused on the most common type of breast cancer, estrogen-receptor positive (or ER+), which comes back as metastatic disease five or more years after treatment in up to 17 percent of early-stage patients. In comparison, the metastatic recurrence rate for all breast cancer patients is thought to be between 20 and 30 percent. “There’s this long tail in ER+ breast cancer where patients will go for years and years without any kind of problem and then five, seven, 10, 15, 20 years later, they have a recurrence,” Ghajar said. Unlike some early-stage cancers, metastatic disease is incurable. Patients with stage 4 disease are in treatment for the rest of their lives. And while some patients live with their cancer for years — or even decades — when their treatment stops working or they run out of options, they die. Ghajar’s finding, if it holds true, could reduce the number of early stagers who go on to become metastatic, effectively snipping off breast cancer’s long tail. “We’re not trying to treat a primary tumor or trying to treat mets,” he said. “We’re trying to treat DTCs, for which there are no current therapies.” Teri Pollastro, 58, another research advocate who worked with Ghajar, went from DCIS, or stage 0, to stage 4 years after her initial treatment. She believes her advanced cancer was a direct result of awakened DTCs. “That’s exactly what happened to me,” she said. “They stopped treatment, and the stuff that was quiet and sleeping came to life.” Fred Hutch prostate cancer researcher and oncologist Dr. Pete Nelson Fred Hutch file photo Uncoupling Dormancy and Chemo Resistance Ghajar said work he did as a postdoc in the lab of Dr. Mina Bissell at Lawrence Berkeley National Laboratory, as well as research done at the Hutch by Dr. Pete Nelson , led him to question the conventional wisdom of DTCs surviving chemo due to their paused cell cycle. “We’ve seen evidence that quiescent cells respond to chemo,” Ghajar said. “They seem to sense when you dump chemicals on them. And there’s been other evidence that architecture — the microenvironment — may be more important than the cell-cycle state in terms of the response to chemotherapy.” Tumor microenvironments are the noncancerous cells and molecules surrounding tumor cells; they're often co-opted by the cancer to help it grow. To pursue this scientific question, Ghajar and his team looked at how DTCs behaved in two preclinical models: mice with breast cancer and organotypic cultures, i.e., human blood vessels and bone marrow tissues growing in a dish. The researchers first dosed mice with chemotherapy, then looked for DTCs in their bone marrow. The only tumor cells that survived were those that were nestled close to the microvasculature, the tiny blood vessels of the bone marrow. They then seeded the organotypic cultures with human breast cancer cells. The tumor cells surrounded by blood vessels grew dormant; those without blood vessels continued to rapidly divide. The team then treated the tiny tumor environments with chemotherapy to determine whether DTC survival was coincidental or something else. “When we added increasing doses of chemotherapy, we noticed that without blood vessels, the breast tumor cells died,” he said. “And with the blood vessels, the breast tumor cells didn’t die. So maybe the blood vessels were protective.” To find out, Ghajar and his colleagues used a growth factor to wake up the dormant cells, then treated them with chemotherapy. Conventional wisdom held that the awakened DTCs would be killed because they were now active and rapidly dividing. But that’s not what happened. “It didn’t matter at all that we had woken them up,” he said. “The chemotherapy had no effect because the blood vessels were there.” Images of mouse femurs from Fred Hutch's Laboratory for the Study of Metastatic Microenvironments show the impact of a new combination therapy on disseminated tumor cells (which show up as green). The top image shows a section of a mouse femur treated only with chemotherapy. The bottom image shows a section treated with both integrin inhibitors and chemotherapy. Ghajar and his team were able to reduce the reservoir of DTCs in the mouse's bone marrow by 94 percent using the combo treatment. Photos courtesy of Laboratory for the Study of Metastatic Microenvironments Silence the Signal, Kill the Cancer The researchers then went about trying to determine what it was about the blood vessels that offered protection to both active and quiescent cancer cells. In collaboration with Peter Nelson’s laboratory at the Hutch, they used RNA sequencing to look at the genes that were being activated or expressed in the organotypic cultures, both with and without the blood vessels. They then used protein analysis or proteomics to discover what, exactly, was being secreted and deposited on the surface of the various cells that might result in this protection. Eventually, They Found the Answer “The main thing that was being enriched when blood vessels were present — as opposed to when they weren’t present — were molecules that bind integrins,” Ghajar said. Integrins are proteins that, among other things, help with cell signaling; they integrate signals from the outside of the cell with the inside of the cell. Humans produce different types of integrins, and there are also several existing molecular inhibitors, or “off-switches,” for them. The research team screened these integrin inhibitors to see if any would interrupt the blood vessels' protective signaling and found two that did just that. They then combined integrin inhibition with chemotherapy and tried it out on the preclinical model of human bone marrow, to great effect. “When we interrupted signaling from those two integrins, we started sensitizing cells to chemotherapy,” Ghajar said. “Chemo on its own would kill one-third of all the single cells in our culture. But when we combined integrin inhibition and chemotherapy, we killed over 90 percent of the single cells in our cultures.” What’s more, the team was able to kill the DTCs without first waking them up, showing that cell division was not necessary to get chemo’s toxic attention. Once the researchers moved onto mouse models with this new combo therapy, they were able to reduce the reservoir of DTCs in their bone marrow by 94 percent. Further, by following the mice for a number of months, they determined their odds of metastatic recurrence were greatly reduced. “With only chemo, over 70 percent of the mice relapsed with mets,” Ghajar said. “But when we used the combo, only about 22 percent of them relapsed with bone mets. We were able to save a lot of mice from relapsing with breast cancer metastases using this approach.” Next Steps for the Science The big question, as always, is “Will it work in humans?” “Oftentimes, you have something that looks beautiful in a mouse, but when you try it in a human, it never works the same,” Ghajar said. “But we really tried hard to mitigate that by the models we used.” Ghajar said his next step will be to make human versions of the molecule he used for integrin inhibition and then test them to make sure they’re safe in people. Once that’s established, the research can move toward a clinical trial that tests the new combo therapy on cancer patients. Although cautious about getting ahead of the science (a clinical trial could be three to five years away), Ghajar does believe his research demonstrates that dormant cells can be killed by chemo without waking them up, which is significant in and of itself. “No matter what happens with regard to the specific molecules we’ve discovered, that concept is going to endure,” he said. Could this potentially help patients currently living with metastatic breast cancer? Ghajar said it’s too early to draw any conclusions about that. “We’re trying to find a way that we can augment therapy up front to kill the roots of metastasis before they arise,” he said. “Would this possibly be a way to eliminate the cells that are going to seed the second met, or the third met, or the fourth? There’s potential, but it’s not something we trialed experimentally.” Pollastro, the patient advocate living with metastatic disease, said she’s optimistic, despite the nascent stage of Ghajar’s work. “Everything starts in a mouse model, doesn’t it?” she said. “I’m very hopeful. And that’s a great next question for him to investigate. Wouldn’t it be wonderful if that worked?” Funding for this research came from Fred Hutch, the Cuyamaca Foundation, a Department of Defense Era of Hope Award, Breast Cancer Research Fund, National Breast Cancer Coalition’s Artemis Project for Metastasis Prevention, Susan G. Komen, the National Institutes of Health/National Cancer Institute, and the Fred Hutch/University of Washington Cancer Consortium. Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine, and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied . Email her at dmapes@fredhutch.org . Are you interested in reprinting or republishing this story? Be our guest! We want to help connect people with the information they need. We just ask that you link back to the original article, preserve the author’s byline, and refrain from making edits that alter the original context. Questions? Email us at communications@fredhutch.org Return to reading more blogs

SurvivingBreastCancer.org had the pleasure of meeting Janine Gilarde during Breast Cancer Awareness Month last October at one of our Survivors, Thrivers, and Friends events. It was one of our first events in MA, and it was a packed house. We know that diet and nutrition are essential components of managing a cancer diagnosis and preventing recurrence. Our event focused on diet, nutrition, plant-based meal plans, meditation, yoga, pilates, and overall health and wellness. It was a natural fit that SurvivingBreastCancer.org and Janine crossed paths, and we are thrilled to partner with her as a guest blogger for our community! By Janine Gilarde, RN & Healthy Living Coach Originally published here on 4/14/2019. Weight gain, especially during or after cancer treatment, can be unexpected and distressing, but it’s not uncommon. Cancer itself — along with side effects from treatments such as chemotherapy, radiation, and surgery — can significantly impact your weight. It’s never too late to take steps to improve your health. Whether you were overweight or obese before cancer, or gained weight during or after treatment, managing your weight after a cancer diagnosis is possible. Common Beliefs About Losing Weight Before being diagnosed with cancer, you may have already tried several ways to lose weight or increase physical activity and found the results discouraging. Here are some common beliefs that may prevent people with cancer from pursuing a healthier lifestyle. “I’VE TRIED EVERYTHING AND JUST CAN’T LOSE WEIGHT” Losing weight is challenging.  You may feel you have “failed” because previous attempts to lose weight have not worked. The truth is that you just haven’t found what works for you yet.  Many people find it easier to lose weight when they have a structured program that offers accountability and support. “THE HARM HAS ALREADY BEEN DONE” It is never too late to improve your health.  Many studies have shown that people who choose healthy foods and exercise regularly are at lower risk of having the cancer return or of developing a new cancer. In addition, changing to a healthier lifestyle reduces the risk of other medical problems, such as diabetes and heart disease . “I ENJOY EATING AND DON’T WANT TO CHANGE MY DIET” You can still enjoy the foods you love, but with more balance. Focus on eating foods that are nourishing, while reducing non-nutritional foods that are high in calories and unhealthy fats. Even small reductions or changes to what you eat and drink can help you lose weight slowly over time. Healthy Diet – Healthy Weight – Healthy Lifestyle Nutrition Nutrition is not just about calories – where you get your calories matters. If you want to improve your health, focus on foods that are nutritionally dense. There are some studies that suggest eating this way can help prevent and reverse many chronic diseases, including cancer. Physical Activity Aerobic and strength training exercise can improve your quality of life, help reduce fatigue, lessen muscle loss, and prevent the gain of body fat.  Physical activity is also important for weight management. Behavior Change Support For many, being overweight or obese is more complex than simply eating too much and exercising too little. It’s important to get support when you are trying to lose weight. There are many studies showing that working with a weight loss specialist/wellness coach can help you make healthy lifestyle changes and stick with them over time. More information about Janine and her healthy tips can be found on her website .

By Store My Tumor You know that the standard of care for cancer is simply not enough, and if your cancer is not contained early on and actively managed, there’s a high risk that the cancer will recur and progress. What you may not know, and is a vital component to advanced cancer treatment, is that tumor preservation is the only way to customized treatments and strategies that are more likely to work. What many cancer patients do not know and often find out too late is that a live cancer tumor is required in order to design personalized treatment options, and how that live tumor is stored is a critical component. If you choose to have your hospital store your tumor, it will NOT be preserved in the right formats. Hospitals routinely discard tumors as medical waste. StoreMyTumor offers a service that can help you collect, process, and store your tumors in multiple formats so that you continue to have access for diagnostics and treatment. Don’t let anyone discard your tumors. Your Tumor Can Help You Answer Tough Questions Preserving the tumor or biopsy in multiple formats is the first step toward developing personalized, effective treatments. With the tumor preserved in the right format at the time of surgery or biopsy, you can answer very big questions, such as: Which chemo is my tumor most likely to respond to? Which one of the thousands of drugs out there may work on my tumor? Are there any experimental drug treatments / clinical trials out there I should consider? Is there a certain combination that may work better than the standard or one drug? Which immunotherapy drug/treatment is available for me? Diagnostics Instead of Guessing There are diagnostic tests that synthesize various data points about your tumor and translate them into specific recommendations that become your personalized cancer treatment roadmap, such as: Genetic testing: Checks for hundreds of targets on the tumor and matches these targets to chemo/drugs and experimental drugs designed for that target. Chemo-sensitivity testing: Tests to determine which chemo is most effective. This is vital because chemo has toxic side effects. Drug screening / Organoids: Tests a wider range (100+) of drugs and combinations of drugs, including chemo, targeted drugs, and immunotherapy drugs. Personalized Immunotherapy Instead of a Wait-and-See Approach Immunotherapy is also another area patients consider. It educates your own immune system to fight the cancer cells. Immunotherapy is experimental, typically considered in parallel to drugs and standard treatments, and helps extend time in remission. In summary, here’s what is possible when you preserve your tumor: Bottom Line No two tumors are alike, and each contains important information critical to the treatment. Tumors are NOT preserved in the right formats by the hospital, and are routinely discarded as medical waste. Don’t let anyone discard your tumors. For more information: call +1 267.702.5501 or www.storemytumor.com Team StoreMyTumor +1.267.702.5501 cs@storemytumor.com www.StoreMyTumor.com Return to the blog .

Written by, Angela Duncan M.S. and Mary Jane Haake, CPCP More information and products can be found at Hip Hemp, LLC. Studies show that up to 50 percent of women suffer from a lack of vaginal lubrication. The condition is not limited to menopausal women and can be experienced at any age. The good news is you’re not alone, and this condition is treatable. Although society is slowly focusing on women’s intimate health issues, there is a long way to go. Studies conducted in 2014 show that of the 64 million postmenopausal women, 32 million suffer from vaginal atrophy. Since women’s intimate problems have been taboo, more than half of these women did not know that their symptoms were caused by menopause or hormonal changes and that their symptoms can be treated and reversed. Other studies conducted show that nearly three in five women have experienced dryness and painful sex. The problem is that nearly 43% of women who have these symptoms will not reach out, or they do not have a place to turn for advice about age or hormone-related changes to their bodies. Without the comfort of talking about intimate health, some women may not know what a normal symptom is and how to treat it, or when they should stop keeping their secret and talk to someone about an easily treatable problem. Education and encouragement are just a couple of ways to help make social taboos of women’s intimate health a thing of the past. Vaginal atrophy is a real struggle that many women of all ages face on their own. Women staying silent about this very real problem can not only affect their health but also affect their relationships and quality of life. Vaginal moisture Some say thin, dry vaginal and vulvar tissues affect 75% of postmenopausal women. But it’s not just midlife or older women who suffer from vaginal dryness. There are a number of other circumstances that can thin and dehydrate your vagina, such as having a baby, nursing, taking hormonal contraception, being treated for cancer with chemotherapy or radiation, and medications such as anti-histamines or decongestants. Vaginal moisturizers are used to prepare and heal your vagina so that you can once again enjoy intimate relations. “In the Pink” organic botanical moisturizers restore balance without the use of chemicals. You literally turn back the clock while you sleep. Consider them a daily “vaginal supplement”. “In the Pink” Moisture Drops are a safe and effective choice that just may change your life. What Can I Do? Vaginal dryness is treatable. The first goal is to find out what is causing your problem and then come up with a plan to help naturally restore your vagina, whether it is stress relief or making a change in your medications. Most natural lubricants on the market will provide short-term relief, but it is important to find long-term relief as well. In The Pink offers a Vaginal Moisture Drop that helps soothe, hydrate, and restore your vagina. This pearl is rich in Omega-3 and 6 linoleic acid with anti-inflammatory, detoxifying, and analgesic properties. This pearl is designed to closely mimic your natural lubrication while restoring tissue elasticity. In The Pink ’s Intimate Massage Oils are a lubrication relief crafted from estrogen-free organic ingredients. This botanical blend is crafted to closely mimic a female’s natural lubrication, along with the added benefits that essential oils have to offer. If you desire an all-natural product to provide lubrication, moisture, aromatherapy, pain control, and enhanced intimate play, this is the lubrication for you.

By William Laferriere A few years back, my girlfriend was diagnosed with Breast Cancer at the tender age of 34. I went into overdrive and performed my due diligence as a Caregiver. I purchased a TV (we hadn’t owned one for years). Now you may be asking yourself - What? All of my research indicated that laughter could play a significant role in the healing process and that improved health and wellness in general could be considerably enhanced by laughter. Ergo, the TV. Understandably, it’s quite difficult to find positivity and levity in a breast cancer diagnosis, but I felt then, and still strongly believe, that comedic relief and positivity should play an indispensable role in one’s treatment. In this blog, we publish links and argue in support of the positive medicinal qualities of laughter. A recent study by the Mayo Clinic found the following: “Whether you're guffawing at a sitcom on TV or quietly giggling at a newspaper cartoon, laughing does you good. Laughter is a great form of stress relief, and that's no joke.” A good sense of humor can't cure all ailments, but data is mounting about the positive things laughter can do. Short-term benefits include organ stimulation, endorphin release, cools down the stress response, and actually can decrease your heart rate and blood pressure. Long-term effects include an improvement to your immune system (positive thoughts can actually release neuropeptides that help fight stress and potentially more serious illnesses), relieve pain, and increase personal satisfaction. Humor lightens your burdens, inspires hope, connects you to others, and keeps you grounded, focused, and alert. It also helps you release anger and forgive sooner. With so much power to heal and renew, the ability to laugh easily and frequently is a tremendous resource for surmounting problems, enhancing your relationships, and supporting both physical and emotional health. By seeking out more opportunities for humor and laughter, you can improve your emotional health, strengthen your relationships, find greater happiness—and possibly add years to your life. Outside Resources Laughter is the Best Medicine Laughter really is contagious—just hearing laughter primes your brain and readies you to smile and join in the fun. The link between laughter and mental health. Laughter stops distressing emotions. You can’t feel anxious, angry, or sad when you’re laughing. Laughter helps you relax and recharge. Stress Relief from Laughter? It's No Joke Laughter enhances your intake of oxygen-rich air, stimulates your heart, lungs, and muscles, and increases the endorphins that are released by your brain. Activate and relieve your stress response. A rollicking laugh fires up and then cools down your stress response, and it can increase and then decrease your heart rate and blood pressure. Laughing Therapy: The 7 Health Benefits Of Laughter Whether you believe in the healing power of humor against illnesses or not, practicing laughing more often will leave you uplifted and refreshed; plus, in the light of laughter, everything always looks a lot better! Laughter: Good For Your Health "Laughter", Provine believes, "is part of a larger picture. Laughter is social, so any health benefits might really come from being close with friends and family, and not the laughter itself". Laughter Meditation: 5 Healing Benefits In fact, laughter can actually alter dopamine and serotonin activity in your brain, offering a noninvasive and non-pharmacological option for dealing with stress and depression. Next time you’re feeling overwhelmed, make time to practice laughter meditation and harness the power of its healing benefits. Emotional Release 6 Reasons Why Laughter Is the Best Medicine | The Chopra Center Studies have found that laughter can have healing properties, and it’s contagious. Here are six reasons why you should start laughing today. Laughter is Contagious. The discovery of mirror neurons—what causes you to smile when someone smiles at you—gives credence to the belief that laughter is contagious. In our research, above is a short video you can follow along with and learn to make yourself laugh instantly! Give it a try and let us know if you were able to achieve a deep belly laugh in the comments! Keep smiling, laughing, and celebrating life!

Each year, the Living Beyond Breast Cancer (LBBC) organization hosts an extraordinary conference. This year's theme was “Sharing Wisdom, Sharing Strength”. There were over 400 attendees, 4 dozen exhibitors, 4 pre-conference networking opportunities, and 11 sessions, all packed into a day of learning in Philadelphia, PA. Some of the topics I’d like to highlight here are: Sex and Intimacy, Connections, Late Stage Breast Cancer, and Knowing Your Body. Sex and Intimacy The subject of physical intimacy was a hot topic that bubbled up among younger women and early-stage breast cancer patients. We hear all the time from younger women diagnosed with breast cancer that they have a unique set of challenges, questions, and experiences. Their concerns differ compared to older women who have been diagnosed with breast cancer and who have had the opportunity to start a family and may have already gone through menopause. Being thrown into menopause, due to chemical/hormonal treatments (such as Zoladex, Tamoxifen, or any of the aromatase inhibitors accompanied by a Lupron shot), may hasten several deleterious side effects, i.e., hot flashes, bone loss, weight gain, and vaginal atrophy . These recurring issues invite us to take a deeper dive, build a community around like-minded individuals, and offer resources and support. We were most fortunate in that we were able to record a podcast with notable Breakout Session Speaker Dr. Monique Gary, DO, MSc, FACs, on this most apropos subject matter. This podcast will be available on “Breast Cancer Conversations” in the coming weeks (found by searching iTunes, Spotify, SoundCloud, etc). Following the LBBC Conference, we hosted a Breast Cancer Survivor/Thriver brunch where we got to meet a number of women under forty who opted not to harvest and preserve their eggs. This was due primarily to their cancers being so aggressive, and their oncologists suggested starting chemotherapy immediately. It's a very personal choice for everyone. No regrets were expressed, and most held onto the acceptance that there are other ways to start a family. For those of you who are looking to start a family, it is important to have this conversation with your oncologist and fertility team so that you can plan ahead and make the best decisions for you. If the question about family planning doesn’t come up in your initial conversation, bring it up! It’s your right! Making Connections It's important that we share stories of those who have been diagnosed with breast cancer. A breast cancer diagnosis can be quite lonely (see related blog post here ). You may have an abundance of support from family and friends, but what we’ve come to realize is that unless you are going through it yourself, it is hard to relate to and understand what it is we are actually going through. At the LBBC Conference, there was such incredible energy. You could approach anyone and immediately dive into a detailed conversation about your diagnosis, treatment plan, and lingering questions without needing to start from the very beginning (and without having to explain the definition of every term). Late Stage Breast Cancer I felt privileged to be able to speak with women who are living with advanced/late-stage breast cancer (i.e., metastatic breast cancer or MBC). These conversations highlighted many different issues. There were many notable concerns and needs compared to the conversations we held with the "early stagers". Women had an opportunity to check a box for what their biggest concerns were, and unanimously, no one checked the box for sex and intimacy. That topic did not play a significant role. Similar to younger women who express unique needs and concerns, these women also shared a similar sentiment. The hot topics of these discussions were: How to manage the good and the bad news Navigating Death (your own or others) Understanding Mortality Here is a most salient notation from the above-referenced conversations: What strategies can we utilize when members of our community pass away because there is no cure? Oncologists may tell you that your disease is not curable, but it is treatable. However, the realities of the prognosis weigh heavily on those diagnosed and their loved ones. The beauty that emerged from these back-and-forth conversations was the appreciation of every detail of life, i.e., feeling the warm sun hit our faces, the taste of ice cream on a summer afternoon, the smell of pine cones in winter, or the beauty of watching the seasons change. Everyone agreed that "life is just different now." This Week’s Survivor Story Kandace M. shares her breast cancer story with us. Her experience brings a lot of these themes together. She is young. Her breast cancer has metastasized. In her first life, she was a marathon runner who qualified for Boston. In her second life, she is a conquering stage IV breast cancer. Know Yourself and Your Body I know many of us consider ourselves to be healthy, we eat well, we have started to follow a more plant-based diet, and we exercise regularly. But even without a genetic mutation, breast cancer can strike (only 10% of diagnoses can be attributed to a genetic predisposition). It may be living within us long before symptoms surface (if they ever do!). You know yourself the best. If something does not feel right, get it checked out, be it a headache, bone pain, or lumpy scar tissue. Know that medical professionals want to be encouraging and tell us not to worry. Sometimes they will not give us the service we are seeking, like a scan or blood test, to give us peace of mind. But if there is a key takeaway from the LBBC conference this year, it is that “we know our bodies the best and persistence is key. If your doctor thinks your symptoms are "nothing", or that "you are too young to have breast cancer," or that "you have no family history" etc., be encouraged to advocate for yourself, get a second, third, or fourth opinion until you find a doctor who will listen to your intuition and partner with you on your medical journey.” XO, Laura