Sunday, September 11, 2011


WHY WE NEED THE BEFORE FORTY INITIATIVE! If a young woman waits to find her lump by palpation- it is a more advanced stage... read this out of the ASCO conference:

Study Supports Palpation, Mammography Regardless of Age
Originally from Elsevier Global Medical News. 2011 Sept 6, S London

SAN FRANCISCO (EGMN) - Many breast cancer patients would have more advanced disease at diagnosis and face harsher treatment if recently updated screening guidelines of the U.S. Preventive Services Task Force were widely adopted, suggests a retrospective cohort study of more than 5,000 women with breast cancer in Michigan.

Study results, being reported this week at a breast cancer symposium sponsored by the American Society of Clinical Oncology, show that nearly a third of the women's cancers were detected by palpation. The guidelines do not advocate for self-exams at all and question the usefulness of clinical breast exams after age 40.

Additionally, nearly half of the cancers in women younger than 50 years were detected by mammography, while the guidelines now recommend against this practice in the 40- to 49-year age group.

Women with palpation-detected cancers had later-stage disease and were significantly more likely to undergo mastectomy and receive chemotherapy than were those with mammography-detected cancers.
"Annual screening mammograms and evaluation of palpable breast masses are important tools in breast cancer detection," second author Dr. Jamie Caughran said during a premeeting press briefing from the American Society of Clinical Oncology (ASCO).

She declined to say whether the study's results contradict the U.S. Preventive Services Task Force (USPSTF) guidelines, as the investigators did not have adequate information on the women's screening history.

But "we take this data to conclude that you're better off if you can ... have your cancer detected by mammography - that you are more likely to have options and less likely to need aggressive treatment. So ... we would support the rest of the societies that continue to recommend annual screening mammography starting at age 40," she said.

 Additionally, this study "highlights the still-significant number of women who present with a palpable mass that shouldn't be overlooked by physicians even if they have a negative mammogram," pointed out Dr. Caughran, medical director of the Comprehensive Breast Center at the Lacks Cancer Center in Grand Rapids, Mich. "So it just continues to reinforce what we believe is inherently true."
Dr. Andrew Seidman, moderator of the press briefing and a medical oncologist at the Memorial Sloan-Kettering Cancer Center in New York City, commented that the appropriate age for starting screening mammography remains controversial.

 "A lot of the debate and focus regarding the utility of mammography have been on overall survival and breast cancer-specific survival, and I certainly think that is the most important end point," he said, noting that the study speaks to another important end point - reduced intensity of treatment.

"As a medical oncologist or chemotherapist, I think this is a very important gain, independent of any potential survival benefit," he said. "Having less disfiguring surgery and the ability to deliver less chemotherapy based on the stage at diagnosis are for me a step forward."

This newest study will not quell the debate, according to Dr. Seidman. "Undoubtedly, this area will continue to remain an area of controversy for some," he said. "But certainly, women in this age group would be well served to know about this data."

 In the study, Dr. Caughran and her colleagues analyzed data from a statewide breast cancer registry managed by the Michigan Breast Oncology Quality Initiative, identifying 5,628 women who received a diagnosis of stage 0 to III breast cancer between 2006 and 2009. Their average age was 59.4 years.
In the cohort overall, 65.5% of breast cancers were detected by mammography, 29.8% by palpation, and 4.7% by other means.

Fully 90% of the cancers detected by palpation were detected by the patient herself, although "it's unclear if the patients ... were practicing regular breast self-examination or if these were incidental findings," noted Dr. Caughran.

When analyses were restricted to women younger than 50 years of age, 48.3% of breast cancers were detected by mammography, 46.1% by palpation, and 5.6% by other means.
Palpation-detected cancers were of later stages (P less than .0001) - two-thirds were stage II or higher - and were more often treated with mastectomy (45.8% vs. 27.1%, P less than .0001) and with chemotherapy (22.7% vs. 15.7%, P less than .0001).

Dr. Caughran and Dr. Seidman reported that they had no relevant conflicts of interest.


Monday, September 5, 2011


Ten years, two cancers later...
Some Lessons by Melody Gardot

"Well, I'm buckled up inside
Miracle that I'm alive
Do not think I can survive
On bread and wine alone

To think that I could have fallen
A centimeter to the left
Would not be here to see the sunset
Or have myself a time

Well, why do the hands of time
so easily unwind?

Some lessons we learn the hard way
Some lessons don't come easy
And that's the price we have to pay

Well, some lessons we learn the hard way
They don't come right off and right easy
And that's why they say some lessons learned
We learned the hard way

Remember the sound of the pavement
World turned upside down
City streets unlined and empty
Not a soul around

Life goes away in a flash
Right before your eyes
If I think real hard, well, I reckon
I had some real good times

Why do the hands of time
So easily unwind?

Some lessons we learn the hard way
Some lessons don't come easy
And that's the price we have to pay

Well, some lessons we learn the hard way
They don't come right off and right easy
And that's why they say some lessons learned
We learned the hard way."

Ten years ago today, I could have fallen a centimeter to the left or to the right. I was told I may not see too many sunsets. But for some reason, I am here. The lessons I learned,  I learned the hard way. I made decisions and changed my life so I could be here for that woman who is like I was, on the pavement with the world turned upside down. I've met the most wonderful friends in the world. I've lost more sisters and cried more tears than I ever thought possible. Their lesson to me was to keep going, keep fighting, and keep the circle growing.

Ten years ago my surgeon turned in his chair and handed me a pamphlet  and said, "Let me tell you about your cancer." Chemo, surgeries, radiation, my first book, my website, a second cancer, chemo, surgeries, radiation, my foundation, my second book, and still learning the lessons I need to know to keep on keeping on.

Thank you to everyone who has been a part of my life since that time... you know who you are. Many of you know me just as nosurrender or g. But you know me, probably better than the ones who know me as Gina.

10 Lessons Learned

1.  Never accept an absolute based on abstract, out-dated stats. You are a snowflake, unique and unlike anyone else.

2.  Learn everything you can. Read every medical book, research study and drug guide before you make any decision.

3.  Don't rely on your doctor to cover everything. Be your own best advocate. Have copies of everything.

4.  Don't rely on anyone. You can't hire someone to go through this for you. You have to do this one on your own. If you expect people will come through, you may be terribly hurt and disappointed. Expect nothing and then be surprised when someone actually shows up for you.

5.  Listen to your inner voice- it may be quiet, almost inaudible at first- but it is telling you that you CAN make it through this if you get your fear under control. You are stronger than you ever imagined you could be.

6. Take those first terror-filled weeks one second at a time. Do not project into the future. Just do what you need to do now and let tomorrow come when you are ready for it.

7.  Make plans. Plant the biggest garden ever if you are diagnosed in the Spring. If you are diagnosed in the Fall, plant as many bulbs as you can find. When your treatments are coming to a close, your victory garden will be a testament to your strength.

8.  Don't hide at home. Get out there and do things. Enjoy every part of your life. Wear pretty clothes to treatment. Pamper yourself so you will remember that underneath the surgery sites and chemo fog you are still you, a vibrant, beautiful woman.

9.  If you hear of someone who is not doing well, don't immediately put yourself into her shoes. You have your own specific pathology, your own special immune system. Stop yourself from asking the particulars of her cancer. It won't help you and it has no bearing on what your prognosis is. Be there for her. Put your arms around her and let her know she has a friend.

10.  Cancer is not pretty, pink, cute or sexy.  It is an enemy that must be destroyed. It's a knife fight, so bring a gun and  fight like hell. Never give in to it. Never let it into your heart. Never lose hope. Remember to laugh as much as you possibly can, because nothing pisses cancer off more. Love with all your heart. And above all, always and forever : No Surrender.