Tuesday, January 31, 2017

Exercise Does Not Prevent Lymphedema in Breast Cancer

The authors found that 31% of the patients wore the sleeve about 75% of the time. Forgetting to wear the sleeve and discomfort were the most frequently cited barriers to its use. For exercise, 55.4% of the patients performed stretching exercises one or more times a week; 47.4% performed strengthening exercises; and 48% performed stretching and lymph flow exercises. Being "too busy" was the most common reason for not doing the exercises.

The attitudes toward exercise were either neutral or favorable. For quality of life, the education-only group experienced a larger decrease in breast cancer anxiety compared to the education-and-exercise group (from baseline to 12 months, P = .04; to 18 months, P = .04). Not surprisingly, Dr Paskett noted, lymphedema status did affect quality of life. At 18 months, scores on the FACT-Band 4 lymphedema subscales were worse for those with lymphedema than those without it (P = .002). Strength Training No Longer Taboo In a discussion of the paper, Ann Partridge, MD, from the Dana Farber Cancer Center, Boston, Massachusetts, commented that these results are disappointing and that they could perhaps be explained by several hypotheses.

One is that the wrong type of exercise may have been used. "Maybe it was not the type of exercise that would benefit these patients," said Dr Partridge. "The physical therapists could have been more focused on range of motion and less on cardiovascular and strength training," she explained, adding that when this study was initiated, strength training was considered somewhat taboo for this population and that that view changed during the study period. Since this study began, research on the use of gradual strength training for breast cancer patients has been published, Dr Partridge pointed out. "These results suggest that not only is progressive weight training not bad for these patients, but it can also improve exacerbation of lymphedema. The study didn't look at prevention, but exercise did not cause it to occur."

Another hypothesis is that confounders may have affected the results. "Even though this was a randomized study, it could have been unbalanced," she said. "They tried to prevent contamination, but we all know that unless you are testing a novel, targeted therapy that you can only get in the cancer center, it is difficult to prevent this." For example, patients can go out and exercise, or they can see a physical therapist. "I think the researchers have collected those data on the patients who were not in this intervention, so we may have more information on that," she said. There are also unmeasured confounders. "One of the biggest predictors of lymphedema is the receipt of radiation to the breast and axillary region," Dr Partridge emphasized. "I should say that it was measured, but the impact has not yet been analyzed." The quality of life data showed that the women in the intervention group experienced more anxiety than the control patients. "Were they upset because they were not adherent, for example?" she questioned. "This really highlights the need for rigorous evaluation of interventions before we adopt them into clinical practice."

Friday, January 20, 2017

Breast Cancer Survivors May Knock Out Lymphedema by Weightlifting

Though stigmatized for a long time, more women are finally starting to come into the world of weightlifting, which offers numerous health benefits – especially for survivors of breast cancer. A recent study published in the journal Supportive Care in Cancer found that it may prevent, or even reverse, lymphedema, a common side effect in patients with breast cancer.

Researchers at Florida State University looked at 27 women who finished primary breast cancer treatment. These women took part in a supervised exercise program that consisted of resistance training twice a week for six months to see what kind of effect this type of exercise would have on lymphedema. “There were only a couple of ladies who had some swelling in their arms,” Lynn B. Panton, Ph.D., FACSM Professor Department of Nutrition, Food & Exercise Sciences at FSU and author on the study, said in an interview with CURE.

“In some ladies, it showed that there was a decrease in the swelling.” The full-body regimen included various machine-based exercises of two sets of eight to 12 repetitions. When a participant used the same weight for 12 repetitions two sessions in a row, she would move on to a heavier weight. Arm circumference was measured at baseline and then every two weeks throughout the study. At the start of the study, three women had pre-existing lymphedema and two of them wore a prescribed compression sleeve to every workout session. No signs of exacerbation were found in all three of the women, and no participant experienced any lymphedema-related adverse events. Panton noted that some of the women were apprehensive about starting an exercise that included weight training.

Not only is there a stigma around women lifting weights – especially for older patients – but doctors also caution patients not to do any upper body exercise for six to eight weeks after surgery. “But then nobody really said, ‘OK, now you’re free to do whatever exercise,’ and a lot of the time, these ladies are scared to do something with their upper body,” Panton said. “And still, there is a stigma for a lot of women with strength training. I wish they would all do it because it’s so beneficial.”

Besides its role in mitigating lymphedema complications, resistance training also proved to help with osteoporosis, a common side effect seen with cancer treatments, and the onset of menopause, as well as overall functionality and quality of life. “It’s huge. The women said that they could do things that, even before surgery, they hadn’t been able to do,” Panton said, citing examples such as carrying groceries and picking up grandkids. “It’s an empowerment and it gives them that self-esteem. The body image improves, too, which is so important.”

Most of the exercises that the women did on the study can also be done with free weights, such as barbells and dumbbells, though patients should be especially cautious if they choose this route—making sure they have the proper technique and balance to safely perform each movement. And, as with any exercise regimen, it is important that patients and survivors speak with their medical team and get their doctor’s clearance before starting resistance training. Even if this type of exercise is not right for some patients, getting out there and moving – in whatever way possible – is key, Panton said. She and her team look to study the results of body weight and impact exercise in the future. 

“Any exercise is important,” she said. “Even for patients who are currently dealing with treatment—if they could at least get out there and do some physical activity, I know it’s difficult, but they do so much better in the long run.”

Thursday, January 19, 2017

Alopecia patient calls for bald emoji to help represent hair loss

Jade Jarvis, 24, from Eastbourne developed alopecia when she was 16. It's a condition that affects around one in every 100 people nationwide and Jade says you may well know someone with it but not realize it. "I used to wear my hood up all the time and never leave the house without my extensions in," she tells Newsbeat.

"I used to wear a little flower on top of my head to try to cover it. "It's quite stressful and hard to deal with at times but my confidence is coming back." After eight years of hiding her condition, Jade started writing a blog about what day-to-day life is like with hair loss. "I've learnt to accept it," she says. "I'm confident in myself and I just deal with it. It's me and if people don't like it then tough." The only character emoji with little or no hair are the baby and elderly man.

Jade says the lack of suitable emoji to go along with her Instagram pictures made her feel down and that alopecia is not accepted socially. She started the petition calling for a new bald emoji to help "people feel more confident". "Emoji are often used when you don't know the words to say and when you suffer from any hair loss condition it's really hard to express yourself. "I think if people were able to use one, it would speak volumes. "There are plenty of politically correct emoji, just none clearly showing a person without hair.

"I feel that by adding a bald male and female we could spread awareness and make this sensitive subject more socially acceptable." Jade was told that 98% of sufferers have regrowth in the first three years and 2% don't. Jade is in that 2%. There is no cure for alopecia and Jade says it's only a matter of time until she has total hair loss. "I am trying to be positive in the hopes that one day, it just might come back," she explains. "However, I have to prepare myself for the worst.

"I know so many people would feel more confident in themselves if they could use this emoji when uploading photos to their Instagram or Snapchat. "It's who they are and they shouldn't be afraid to show it - myself included." For those experiencing alopecia, Jade has this advice: "I know that it is not easy, but one of the greatest hurdles you have to cross is the one where you realize that you don't need to hide who you truly are.

"Believe me, once you cross it, the greatest weight comes off your shoulders and you become a stronger person. "It has taken me six years to get to the stage that I am at now, but now I am here I feel so much more lifted and full of self-confidence."

Friday, January 13, 2017

Before Breast Cancer Surgery, A Question Every Patient Should Ask Her Surgeon

Usually a person with a new breast cancer diagnosis knows she has a decision regarding surgery: lumpectomy or mastectomy. Plenty of articles implore women and surgeons to avoid the bigger operation when possible, because mastectomy does not offer a survival advantage over lumpectomy. I have written previously about that choice. One aspect of breast cancer surgery that’s less often discussed—about which patients may not be aware—is the method by which doctors check glands under the armpit.

The old way to evaluate if cancer has spread is called axillary lymph node dissection. That procedure, in which surgeons remove as many glands as they can find in the armpit, carries significant risk of lymphedema, a sometimes painful arm swelling, and other complications. The modern way to see if cancer has spread to nearby glands is called sentinel node biopsy. In this less drastic procedure, just a couple of lymph nodes are removed from the armpit. Taking a biopsy of “sentinel” nodes—selected after injection of labeling material, such as a dye or radioactive tracer, into the breast tumor—has been routine in many academic and cancer centers for over a decade, and is associated with lower rates of complications including lymphedema, and lower costs. It’s been at least 22 years since surgeons reported on this technique (in 1994).

Yet in only 60 to 80% of relevant breast cancer cases do surgeons perform only the lesser procedure, said Dr. Gary Lyman in a phone interview. He’s an oncologist and professor of public health at the University of Washington who co-directs the Hutchinson Institute for Cancer Outcomes Research in Seattle, and an author of updated ASCO guidelines published last month. The ASCO recommendations, like the American Society of Breast Surgeons consensus statement, support use of sentinel node biopsy in most cases of early-stage invasive breast cancer. Full lymph node removal is an unfortunate and common example of breast cancer overtreatment, Lyman said. “Approximately two-thirds of women with early-stage breast cancer can safely undergo the sentinel node procedure without axillary node dissection,” he said. “If the sentinel node is negative, it was established years ago that a patient can skip the full axillary node dissection,” Lyman said.

“Now we know that in most early-stage cases, even with a positive sentinel node, the dissection can be skipped,” he said. “There are caveats,” he indicated. (See this paper for details, and below.) “The advantages of avoiding lymph node dissection are several,” Lyman said. “Quality of life is improved.” Chronic arm swelling is not nearly so frequent a complication of breast cancer surgery as it once was, he considered. “Surgeons have improved their skills. But it still happens.” The swelling can be problematic. “Women may be unhappy about the appearance of a swollen arm or hand. Some can no longer use their arm as before,” Lyman said. “It depends on what they do with their life, and for a living. If a woman types or if she’s a pianist, lymphedema is a big deal.”

Disparity in overtreatment is a significant concern, Lyman emphasized. Patients without insurance, with lower income, and who are less educated are more likely to have lymph node dissection, he said. “Uptake in major cancer centers has been substantial, not perfect but very high,” he said. “Many patients are still treated in community settings,” he said. “Based on Medicare and other billing data, we know that’s where more surgeons still perform full axillary lymph node dissections,” he considered. “I feel strongly that most patients should be referred to a breast surgeon for this kind of surgery, ideally at a cancer center.” “With sentinel node biopsy, the risks of developing infection or lymphedema go way down,” Lyman said. “Sentinel node biopsy lowers costs. There’s not a huge difference in operating room costs,” he noted. “But hospital stays are shorter, and problems with subsequent infections are reduced.” Cynthia ("Cjay") Judge is a cancer survivor who advocates for people affected by lymphedema.

At age 68, she lives in Las Vegas and co-hosts the Lymphedema Mavens podcast. “I experienced lymphedema over 30 years ago,” she told me by phone. “When I had my cancer surgery, no doctor even mentioned the possibility of lymphedema.” Judge participates in several lymphedema support groups on Facebook and advocacy organizations including the National Lymphedema Network. “Every day I hear of people affected,” she said. “Some women have had it forever, living for lymphedema for years, and some don’t know that’s what it is until they hear about it from other patients,” Judge said. “Without proper care, they are really prone to cellulitis. People need to know about it before they have their surgery.” “I’m a bit surprised that some doctors are not doing the sentinel node biopsy,” Judge said when we discussed the updated guidelines last month. “Actually, I’m stunned,” she continued.

“There’s usually no reason to take out a gaggle of lymph nodes.” “Women need to educate themselves before surgery, Judge said. Sentinel node biopsy still has risks, she considered. “It’s not foolproof. You can still get lymphedema, but the risk is lower,” she said. “If your doctor is not familiar with the procedure, you can get a second opinion or if at all possible, go elsewhere." “There are doctors who say to me, I don’t know much about it,” Judge said. “That’s really sad. They should learn more about it, and follow the guidelines, because lymphedema is so devastating.” The effectiveness and safety of sentinel node biopsy for breast cancer staging—as opposed to the larger, full axillary node dissection—is supported by careful studies over the past 20 years.

In 2003, a randomized trial showed that sentinel node biopsy helpful, and not harmful, for women with tumors of less than 2 centimeters. By 2005, the American Society of Clinical Oncology (ASCO) issued guidelines deeming the sentinel node method an “appropriate initial alternative to routine staging” for early-stage breast cancer patients. A decade ago, the routine in many hospitals was for women to undergo sentinel node biopsy with intra-operative pathology evaluation of the sentinel node or nodes; if those results were negative, dissection would be stopped. In 2011, a published JAMA trial showed that even when the sentinel node is positive, there is no survival benefit in full node dissection.

The emerging “less-is-more” consensus was that the reason to do lymph node sampling is primarily for staging purposes—establishing prognosis and planning treatment—but that removing all the glands in early-stage cases doesn’t help and may cause net harm. But some doctors hesitated to adopt this recommendation. In 2014, ASCO published guidelines based on a literature review, quite similar to those updated last month. Exceptions and areas of uncertainty include breast tumors of greater than 5 centimeters, inflammatory breast cancer, DCIS and some other circumstances. The recommendations to avoid axillary node dissection don’t apply to patients with advanced, stage 3 or 4, breast cancer. An area of controversy pertains to neoadjuvant chemotherapy, Lyman said. That’s when patients receive chemotherapy before definitive surgery in an effort to shrink the tumor first. “This is an area of investigation.” Lyman referred to several preliminary papers on this subject presented at last month’s San Antonio Breast Cancer Symposium.

“Historically we have recommended that the best results are doing the sentinel node before the chemotherapy.” But some patients or surgeons may prefer just one surgery, and so the sentinel node is checked only after patients receive some chemotherapy. “Neoadjuvant chemo can affect the lymph nodes. If they’re negative, that may give a false sense of security, that you don’t need to give hormonal or chemotherapy,” he said. “In this setting, the false negative rate will be higher. It’s a less meaningful finding. The patient needs be aware of that.” The updated guidelines apply to many, many patients: In this year alone, over 150,000 U.S women will undergo surgery for early-stage invasive breast cancer. In most cases—when lumpectomy followed by radiation to the armpit is planned—axillary node dissection is no longer advised.

This is the two-part question patients should ask their breast cancer surgeons: “Can you perform a sentinel lymph node biopsy, and avoid removing all of the glands from my armpit?”

Wednesday, January 11, 2017

Why Millennials Seem to be Experiencing More Hair Loss

Hair loss is something we associate with aging, not a younger population, and yet more and more millennials say they're experiencing hair loss. When Diana Damian was just 32, she started noticing her hair falling out.

At first, she figured it was due to post-pregnancy changes, but then she realized it was something more. "Every time my hair would fall out, every time I'd look in the mirror, every time I'd brush my hair, especially in the shower, globs of hair would just fall down," said Damian. Initially, she tried drug store treatments and even looked up do-it-yourself remedies on YouTube. When nothing worked, she turned to dermatologist Candace Thornton-Spann.

"Millennial hair loss is something that I'm seeing quite a bit of in my practice," she said. Thornton-Spann said there is no evidence hair loss happens more to millennials than to earlier generations, but she thinks previous generations hid under wigs or just didn't question it. "In this generation, there is no taboo, there is only the drive to seek answers and I think that's probably what's driving the increase in numbers that we're seeing," said Thornton-Spann.

There are many known causes of hair loss in young women, including hormonal changes, autoimmune diseases, thyroid disorders and stress, which is what caused Damian's issues. She said, "I suffer from anxiety, from depression and especially when you notice that you're losing so much hair, the stress only gets worse." What you eat or don't eat can make a difference, too. "The trend these days is to exclude large parts of the diet.

So, I see young women who may have completely stopped eating meat. Hair is made of protein, so it makes sense that if you are not getting adequate protein, you cannot grow adequate hair," said Thornton-Spann. Treatments can range from supplements to surgery. Damian is happy she sought the advice of a doctor. "I'm so much happier now, I'm always just flipping my hair," she said. In addition to health-related causes of hair loss, experts say many popular hair-styling practices like tight braids, hot styling tools and other things can damage hair, too.

Tuesday, January 10, 2017

Mammograms may do more harm than good for many women with breast cancer, study says

One in three women with breast cancer detected by a mammogram is treated unnecessarily, because screening tests found tumors that are so slow-growing that they’re essentially harmless, according to a Danish study published Monday in Annals of Internal Medicine, which has renewed debate over the value of early detection. The study raises the uncomfortable possibility that some women who believe their lives were saved by mammograms were actually harmed by cancer screenings that led to surgery, radiation and even chemotherapy that they didn’t need, said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who wrote an accompanying editorial but was not involved in the study.

Researchers increasingly recognize that not all breast cancers pose the same risk, even if they look the same under a microscope, Brawley said. While some early tumors turn into deadly monsters, others stop growing or even shrink. But assuming that all small breast lesions have the potential to turn deadly is akin to “racial profiling,” Brawley wrote in his editorial. “By treating all the cancers that we see, we are clearly saving some lives,” Brawley said in an interview. “But we’re also ‘curing’ some women who don’t need to be cured.”

Although experts such as Brawley have long discussed the risks posed by “overdiagnosis,” relatively few women who undergo cancer screenings are even aware of the debate. The American College of Radiology, which strongly supports breast cancer screenings, acknowledges that mammograms lead some women to be treated unnecessarily, but said the problem is much less common than the new study suggests. Another study from Denmark – whose national health program keeps detailed records – estimated the overdiagnosis rates at only 2.3 percent. “The amount of overdiagnosis really is small,” said Dr. Debra Monticciolo, chair of the American College of Radiology’s Commission on Breast Imaging. “Articles like this aren’t very helpful,” she said, because they leave women confused about how to be screened for breast cancer.

Yet treating women for cancer unnecessarily can endanger their health, said Fran Visco, president of the National Breast Cancer Coalition, an advocacy group. Radiation can damage the heart or even cause new cancers. Visco notes that breast cancer activist Carolina Hinestrosa, a vice president at the coalition, died at age 50 from soft-tissue sarcoma, a tumor caused by radiation used to treat an early breast cancer. Women should understand these risks, Visco said. Instead, women often hear only about mammograms’ benefits. “Women have been inundated with the early detection message for decades,” Visco said. The risks of overdiagnosis and false positives, which can lead women with benign growths to undergo biopsies and other follow-up tests, have caused some experts to reevaluate breast cancer screenings.

Although mammograms don’t find all tumors, they reduce the risk of dying from breast cancer by 25 percent to 31 percent for women ages 40 to 69, according to the Agency for Healthcare Research and Quality, part of the Department of Health and Human Services. In the new study, Danish researchers estimated the rate of overdiagnosis by comparing the number of early-stage and advanced breast tumors before and after the country started offering mammograms. If screenings work as intended, the number of small, curable breast tumors should increase, while reducing the number of large cancers by about the same amount. Although mammograms in Denmark detected a lot more breast cancers, these were mostly small, early-stage tumors, said study coauthor Dr. Karsten Jorgensen, a researcher at the Nordic Cochrane Center in Copenhagen, Denmark. The number of advanced cancers did not fall. The debate about overdiagnosis illustrates the limits of medical technology, Brawley said.

Although researchers can estimate the statistical rate of overdiagnosis, doctors treating actual patients can’t definitively tell which breast tumors need treatment and which might be safely ignored, Brawley said. So doctors tend to err on the side of caution and treat all breast cancers with surgery and, in many cases, radiation and chemotherapy. An estimated 253,000 new cases of breast cancer will be diagnosed in U.S. women this year, with nearly 41,000 deaths, according to the American Cancer Society. An additional 63,000 women will be diagnosed with ductal carcinoma in situ, also known as DCIS, which has some, but not all, of the typical traits of cancer. Although DCIS cells have changed to appear malignant under the microscope, they haven’t invaded surrounding tissue. The American Cancer Society defines DCIS as the earliest stage of breast cancer, and women with the condition typically undergo the same treatment given to women with early invasive cancers.

Although DCIS isn’t life-threatening, doctors recommend treating it to prevent it from becoming invasive. Other experts note that DCIS carries such low risk that it should be considered merely a risk factor for cancer. Researchers are conducting studies to measure whether it’s safe to scale back treatment of DCIS.

Thursday, January 5, 2017

Daily movement can come in a number of ways, whether it’s reaching a certain number of steps, a gym class or even just rising from your desk at work.

And here’s a new option to add to your routine: A seven-minute, heart-pumping workout you can do virtually anywhere.
Hannah Bronfman, founder of the wellness site HBFit.com, breaks down the full-body routine in the video.

All you need is comfortable clothing, enough space to move around and a mat if you would prefer. Bronfman guides you through the movements, which include jumping jacks, side kicks and a bit of abdominal work to break a quick sweat. Movement does wonders for your body and your mind: It can help you cope with stress and potentially reduce the risk of heart disease and even improve self confidence. And now you can reap those benefits in under 10 minutes. Need we say more?