10 things breast cancer doctors wish you knew

1. I have breast cancer. Am I going to die? According to several doctors participating in Pink Power TODAY, this is a common question women ask immediately after being diagnosed. "Breast cancer is not a death sentence," Dr. Deepa Halaharvi, a board-certified general surgeon specializing in breast surgery, told TODAY via email. "Most people do really well and 5-year survival for all stages of breast cancer is 91 percent. We really need to be catching this at an early stage."

2. I don't have a family history of breast cancer. Why did I get it? "Most commonly, breast cancer is sporadic and most people (85 percent to 90 percent of breast cancer patients) don’t have a family history of breast cancer," said Halaharvi. "It’s a common misconception that it’s inherited through a family history. So regular screenings are very important, regardless of what your family history may be. At OhioHealth, we recommend average-risk women begin screening mammograms at age 40." According to the American Cancer Society, women ages 40 to 44 should start having annual mammograms if they want. Women ages 45 to 54 should get mammograms every year, and women 55 and older should switch to every two years, or can continue yearly screenings.

3. What are the most important risk factors for breast cancer? "A previous history of breast cancer, a significant family history of the disease (particularly when a genetic mutation in BRCA1 or BRCA2 are present), and specific conditions such as atypical hyperplasia and LCIS that are only detected when breast tissue is biopsied and examined microscopically," explained Dr. Freya Schnabel, the director of breast surgery at Perlmutter Cancer Center at NYU Langone. Schnabel noted that these risk factors have different magnitudes, and you should try to discuss with your doctor what makes a family history significant (close relatives, diagnosed at young ages, multiple generations).

4. I am a BRCA carrier. What do I need to know? "BRCA carriers are the highest risk group for breast cancer," stated Schnabel. "BRCA1 carriers are at risk for breast and ovarian cancer — their lifetime risk for breast cancer may be as high as 50 to 85 percent. BRCA2 carriers have a 40- to 60-percent lifetime risk for breast cancer, and are at an increased risk for ovarian cancer, and are also at increased risk for pancreatic cancer." According to Schnabel, BRCA carriers have three options to manage their breast cancer risk: intensive surveillance (to maximize the opportunity for early detection of disease should it occur) chemo-prevention (the use of drugs like tamoxifen to reduce the risk of developing breast cancer) risk-reducing surgery (bilateral mastectomies with reconstruction to lower the risk of breast cancer to as low as we can make it)

5. What can you tell me about the alcohol and breast cancer link? While countless studies support that wine is good for your heart health, you have to weigh these benefits against its link to cancer. "There is good evidence that alcohol increases the risk for breast cancer," Schnabel explained. "Specifically, women who drink at the rate of seven drinks per week have about a 20-percent increase in their risk for breast cancer."

6. My mother was diagnosed with breast cancer at 45, when should I start getting mammograms? "If you have a family history of breast cancer, you should start screening mammograms 10 years prior to your family member getting diagnosed," Halaharvi explained. "So in this case, you’d start at age 35. Again, make sure to talk with your physician and discuss your family history."

7. How quickly do I need to start treatment for my breast cancer? When you're first diagnosed, it may feel like there is pressure on you to decide on a treatment plan right away. But Dr. Lisa Newman, a breast cancer surgery specialist at Henry Ford Health System in Detroit, advises clients to take a beat to process everything and make the right decision for you. "You should not feel that you are 'racing the clock' — the cancer is not spreading or becoming more advanced in your breast or your body by the day," Newman said. "You have the time to make sure that you are properly informed about your cancer diagnosis and treatment options before jumping into something irreversible."

8. Should I get a second opinion? For many women, taking the time to weigh their options means getting more than one medical opinion, or looking into clinical trials or research studies, Newman said. "There is no magic deadline," she stressed. "But a general rule of thumb is that we don’t like to see patients delaying the start of their treatment more than four to six weeks after the diagnosis has been made. The stage and type of breast cancer can influence how quickly the treatment should be initiated."

9. There are so many conflicting reports about breast self-exams, should I be doing them? The American Cancer Society no longer recommends frequent breast self-exams because research has found they don't provide a clear benefit or save women's lives. However, it does stress that women should have self-breast awareness — "be familiar with how their breasts normally look and feel and report any changes to a health care provider right away." "Women should be aware of changes to their breasts such as a palpable mass, skin changes, nipple discharge, skin dimpling, nipple inversion and mass underneath the arms such as enlarged lymph nodes," Halaharvi stressed. "You don’t necessarily need to have a mass to have breast cancer such as inflammatory breast cancer (redness, an orange peel appearance) are seen."

10. How and when should I tell my children? This is one of those answers that is tricky, depending on the ages of your children, but Newman offered this advice: "In general it is best to be as honest with them as possible, because they are likely to sense and/or see that something major is happening, and it is important to provide them with reassurance that you are taking care of yourself," she said. "Very young children may need to also be reassured that cancer is not contagious like the flu, and older children may actually feel empowered if they are allowed to help out and provide support during your treatment. All children need to understand that the cancer diagnosis was not anyone’s fault."

How exactly does obesity cause cancer? Three leading theories

‘Love handles’, ‘muffin top’, ‘beer belly’, ‘extra padding’, ‘cuddly bits’, ‘winter insulation’… We all have names for the squishy bits we keep meaning to lose – but apart from not fitting into our favourite jeans, carrying too much weight isn’t actually doing any harm, is it?

Unfortunately, it is. And we’ve written several posts about the link between being overweight or obese and several types of cancer (here’s the most recent).

But despite efforts to raise the profile of the link, public awareness remains stubbornly low – only around one in 10 people name being overweight as a factor when asked what things they think affect a person’s chance of developing cancer.

This is an urgent problem: the world is slowly drifting into an obesity crisis, with the condition already linked to nearly 500,000 cancer cases worldwide every year.

According to recent reports, public health experts predict that – shockingly – in the US obesity will soon overtake tobacco as the leading preventable cause of cancer – and the UK might one day follow suit.

So it’s clear that those spare pounds aren’t a mere overflow car park for excess doughnuts.

But that raises a crucial question: how exactly does fat increase our risk of cancer?

While there are several plausible explanations, it’s an answer that researchers are still working hard to figure out. But first… just what is fat?

Fat isn’t just padding: it’s like another organ

Fat (also known as adipose tissue) has two main roles in the body.

Primarily it exists to store calories in the form of chemicals called lipids, which – when food was scarce would serve as a back-up energy store to keep us going. But nowadays many people consume more calories than they use up, leading to more of us becoming overweight or obese.

But the fat in your body also has a secondary function – it’s essentially a huge gland, sending out a constant stream of biological information and instructions that affect the rest of your body. This helps control processes like growth, metabolism and reproductive cycles.

But because of their ability to turn biological processes on and off, the signals produced by fat have a darker side when it comes to cancer.

This is especially true when people become overweight or obese – the point at which excess fat has a negative impact on health. Here are the three leading theories about how excess fat might lead to cancer, and the scientific evidence behind each one.

1. The oestrogen connection

One of the strongest links between obesity and cancer is an increased risk of breast and womb cancers in women who are overweight or obese after the menopause, and this relates to higher oestrogen levels.

In pre-menopausal women, the ovaries are the main oestrogen-producing cells. But fat cells can make oestrogen too and, after the menopause, when the ovaries stop working, fat becomes the chief source of the hormone. And there is solid evidence showing that being obese leads to higher oestrogen levels in women after the menopause.

Professor Martin Wiseman, a leading expert on diet, weight and cancer from the World Cancer Research Fund, is in no doubt that oestrogen made by fat cells is a leading culprit in postmenopausal breast and womb cancer.

“The evidence that oestrogen plays a central role in some cancers is black and white. Oestrogen makes certain cells – like breast and womb cells – divide, so too much oestrogen can encourage cells to keep dividing when they shouldn’t be. And uncontrolled cell division is fundamentally what cancer is.

“Large studies of women have shown a direct relationship between obesity, high oestrogen levels and breast and womb cancers”, he explains, “and understanding this relationship has been critical in developing effective treatments – like tamoxifen and aromatase inhibitors – that work by cutting off oestrogen.

“Furthermore, if women at high risk of breast cancer are given oestrogen-blocking treatments, fewer go on to develop the disease. Cutting off oestrogen can stop breast cancer developing.”

While the link to women’s cancers is stronger, there’s also data suggesting that obesity-related changes in sex hormones can play a role in men’s cancers too. There’s evidence that, while rare, breast cancer in men is linked to increased oestrogen caused by excess body fat. Obesity is also linked to higher rates of aggressive prostate cancer, but it’s unclear if changes in oestrogen from fat cells play a role, or whether  it could be down to changes in testosterone, the male sex hormone.

2. Metabolic chaos

The chemical processes going on constantly throughout the body – collectively known as metabolism – are complicated and tightly controlled, relying on a finely tuned web of information flowing between cells and organs.

But the chemical signals produced by fat cells means that obesity can cause a major upset to this balance, and this is thought to be another way it makes cancer more likely.

One key hormone that acts as a master-controller of metabolism is insulin. It’s made by the pancreas and orchestrates how cells take up and process glucose from the blood.

But insulin’s instructions can be overridden by chemicals in your blood known as free fatty acids – the levels of which can be affected by eating a fatty meal, for example. This flips a switch in your liver and muscles, telling them to use this fat as fuel instead of glucose.

But it’s not just eating fatty food that increases free fatty acid levels in blood. Body fat, especially around the abdomen, can also release them – it’s the body’s way of using up fat stores. Excess body fat can lead to rising  levels of free fatty acids, leaving cells increasingly resistant to the effects of insulin and unable to take up glucose properly.

“This can cause all kinds of problems”, Wiseman tells us. “Cells become resistant to insulin, so the pancreas makes more to try and compensate and bring blood glucose levels back down”.

And these long-term raised insulin levels could be another way being obese raises the risk of cancer, he says.

“Higher amounts of insulin have a knock-on effect of re-programming the levels of growth factors available to cells, and both insulin and these growth factors can become a danger when it comes to cancer. Growth factors are a green light signal for cells to divide”.

There’s also substantial laboratory evidence of a link: lots of data showing that as cancer cells react to both insulin and insulin-related growth factors, they become harder to kill, and divide more quickly.

“Large studies of peoples’ blood chemistry have also shown links between high glucose (even at levels below those needed for a diagnosis of diabetes) and the risk of several types of cancer,” Wiseman tells us.

Taken together, the evidence that disturbances in metabolism lead to cancers is compelling.

The big question is the degree to which it plays a role in the increased rates of cancer in obese people – and studies are on-going to find this out.

3. Inflammation

As people become obese, and more fat cells build up in their tissues, specialised immune cells (called macrophages) are called to the scene, possibly to clear up dead and dying fat cells.

But as macrophages carry out their clean up job, they also release a potent cocktail of chemicals called cytokines that summon other cells to help them out. The number of macrophages in obese fatty tissue can be substantial – they can account for as many as four in 10 cells.

This ultimately creates a condition called chronic inflammation – and this is another way that obesity is thought to fuel the development of cancer. And it’s been shown that obese people tend to have higher levels of inflammatory cytokines in their blood.

We’ve written before about how inflammation can be a double-edged sword – while it’s an essential part of our immune defences, it can also aid and abet the growth and spread of cancer.

The evidence that inflammation is linked to cancer is damning. Many chronic inflammatory diseases (such as pancreatitis and Crohn’s disease) can increase a person’s risk of cancer. And cancers caused by infections are also characterised by chronic inflammation.

Wiseman explains “the result of inflammation is a cocktail of signals that tell cells to divide, because after injury you need new cells for healing to occur.

“But the signals encouraging cell growth for healing can also support cancer cells dividing. In fact if we look at the genes that are turned on and off in inflamed tissue, it’s very similar to genetic changes we see in cancer cells.

“There’s strong evidence that aspirin, a drug that reduces inflammation, prevents bowel cancer, or other anti-inflammatory drugs may also be beneficial when it comes to treating, and possibly preventing, other types of cancer.”

This doesn’t add up to concrete evidence of inflammation playing a role in cancer, but it certainly points a strong finger of accusation in its direction.

The long and short of it

There’s not a shadow of doubt that obesity is linked to cancer, but unravelling the biological reasons why is proving complicated.

Being obese affects lots of different aspects of our physiology – hormones, growth signals, and inflammation. It also affects different people in different ways; for example, not everyone who is obese will have abnormal metabolism or chronic inflammation.

To make matters more complicated still, oestrogen, insulin, and inflammation are a convoluted tapestry of interwoven threads. None of them in isolation directly causes cancer, but in obesity they knit together to form a lethal fabric – dampening the delicate systems that balance our bodies with disastrous consequences.

And while it’s not simple to understand how the threads weave into the overall picture, researchers know that there’s potentially an opportunity to treat, or even prevent, cancer by developing drugs that override signals made by fat cells. For example, both metformin (a diabetes drug that affects insulin levels) and aspirin (which dampens down inflammation) are under investigation as possible anti-cancer drugs.

We’ve focussed on cancer here, but of course that’s only part of the story. Obesity is a leading cause of death from other serious diseases too – diabetes, heart disease and stroke to name a few.

So we urgently need to tackle the obesity crisis head on. And you’ll be hearing more about how over the coming months. As more people become overweight or obese (many without even realising it), the number of people dying from related diseases is rocketing. It’s not something we can afford to ignore.

Lymphedema Prevention Tips

If you have had treatment for gynecological cancer, which may include surgery, the removal of lymph nodes and radiation, you are at risk for developing lymphedema. This could occur shortly after or many years post cancer treatment. Even though there are no guarantees to prevent lymphedema, there are ways to help minimize the possibility of developing this chronic condition.

• Learn as much as you can about the lymphatic system and lymphedema.
• Set up a “preventative” appointment with a Certified Lymphedema Therapist.
• Do not allow any medical treatment to be administered on the “at risk” limbs. No IV, no blood sticks, no injections, no blood pressure readings.
• Avoid acupuncture needles placed in the “at risk” limb. Although these are very fine needles, it still is a break in the skin.
• Protect against insect bites or sunburn that can damage the skin.
• Wear compression garments when flying. Cabin pressure changes may trigger an initial onset of lymphedema.
• Maintain a normal body weight. Being overweight adds excess strain or may block the lymphatic system to the already at risk limb.
• Exercise regularly. Seek professional advice after cancer treatment regarding the type and intensity of your exercise regimen. Returning to your previous exercise program too fast or too intense may overload the lymphatic system.
• Avoid steam rooms, hot tubs, and saunas. These treatments increase swelling and may trigger lymphedema.
• Avoid prolonged sitting or standing.
• Avoid crossing your legs.
• Wear well-fitting shoes.

Ten Questions to Ask Your Doctor About Ovarian Cancer:

1. Has my ovarian cancer spread?

2. Do I have to have both of my ovaries removed? If so, will I have hot flashes?

3. How confident are you that all of the cancer has been removed?

4. Which chemotherapy drugs do you recommend? Do I have any other treatment options?

5. How long will I have to undergo chemotherapy?

6. What side effects should I look for? Are there ways to minimize these side effects?

7. Will I need any additional surgery?

8. Should I be tested for the BRCA-1 BRCA-2 mutations? What should I do if the test is positive?

9. What signs should I look for that might indicate the ovarian cancer has come back?

10. How often should I come in for follow-up visits?

Congratulations to Our Winners!

Thank you all for supporting our Wigs for Wonderful Women - Women's Cancer Wig Giveaway! Since we had such a great response, we decided to expand our giveaway and are now giving away three synthetic hair wigs! We have our winners...

Grand Prize, Winner of a Human Hair Wig - Lori Fransworth

Runners up, Winners of a Synthetic Hair Wig- Janet Wilder & Amanda Larson & Theresa Packer

Congratulations ladies! We are looking forward to getting to know you and to seeing you in your glamorous head of customized hair!

Women's Cancer Wig Giveaway!

Are you or do your know a wonderful woman going through cancer treatment? Then enter our giveaway contest by emailing Kristen at kristen@hairandwellness.com and tell us your story or your loved one's story. We are looking to give away a free human hair wig like the one our client, Rosemary is wearing. She loved her fully customized wig so much that she named it "confidence!" Our world-renowned hair duplication master stylist will color, cut and customize your new hair to give you extra confidence while going through cancer treatment. Our contest is open to women with any type of cancer. We are thrilled to give away "Wigs for Wonderful Women!" For more information, visit www.hairandwellness.com

Wigs for Wonderful Women - A Women's Cancer Wig Giveaway

In observance of October’s Breast Cancer Awareness Month, Ricky Knowles Hair and Wellness, the leading master stylists of high-quality, natural and synthetic wigs and hairpieces, is hosting “Wigs for Wonderful Women” a Women’s Cancer Wig Giveaway throughout the month of October.

Participants from the Houston-area can write a story about their personal journey with cancer, or a friend or family member of a woman with cancer can share how their loved one who has cancer inspires them.

The grand prize winner will receive a completely customized human hair wig, beautifully designed and styled by world-renowned hair duplication master stylist, Ricky Knowles. Two (2) second place winners will receive a completely customized synthetic hair wig, beautifully designed and styled by world-renowned hair duplication master stylist, Ricky Knowles. Ten (10) third place winners will receive a beautiful pre-tied head scarf and Neuma travel size shampoo, conditioner and organic scalp treatment.

All entries must be submitted by 11:59 pm on Sunday, November 2, 2014.

Submit stories via email to kristen@hairandwellness.com.

For more information about the contest, visit: http://www.hairandwellness.com/winwigs.html