Wednesday, March 4, 2015

Finding Lumps After Breast Reconstruction

Guest Post

Finding lumps after breast reconstruction

Published Aug 14, 2008
For the most part, my reconstructed breasts are smooth and natural. Pressing in on them, however, reveals to me small, hard masses. I only have a couple that I can find, but it did cause some alarm initially. The surgeon assured me that they were fat tissue that had hardened as a result of the transplanted tissue and were completely unrelated to any breast cancer issues. I sometimes wonder if I am completely safe though. Last week the other breast cancer blogger on HealthTalk, Suzette, wrote about her recent experience in finding a lumpand undergoing a biopsy only months after breast reconstruction. The thing I admire about Suzette is her knowledge of her body and her vigilance against recurring breast cancer. I learn a lot from reading her blog posts. Thankfully, the results were negative, but it got me to thinking again about all of us with reconstructed breasts.
For one thing, how will we ever know if breast cancer begins growing on the muscle wall behind implants or transplanted flaps? I know the oncologist takes blood tests to help determine if our body is reacting to a new cancer, but how do we stay on top of this without a mammogram or other screening? It is easy to fall into a sense of security from having our breasts removed, but there can be recurrence in the muscle and wall of the chest. Oh brother. Suzette’s recent adventure brought this to light for me and I plan to contact the reconstructive surgeon to ask what he suggests and also review this with my oncologist at my next visit.
We all now know that our best defense against breast cancer is to be proactive, I am glad that Suzette is a great example of what we all need to do to stay cancer-free.


Saturday, January 17, 2015

Study Finds Breast Cancer Varies By Race

new study published in JAMA finds that among women in the US, the chance of being diagnosed with breast cancer in the early stages of the disease and the likelihood of surviving after such a diagnosis may be influenced by race and ethnicity, and this may be down to biological differences.

A woman having a mammogram
According to the American Cancer Society, white women are more likely to develop breast cancer than African American women, although African American women are more likely to die from the disease.
According to the American Cancer Society, there will be around 231,840 new cases of invasive breast cancer - in which the cancer cells have spread beyond the breast ducts - diagnosed in the US this year and more than 40,000 deaths from the disease.
It is already known that breast cancer incidence in the US varies by race and ethnicity. Overall, white women are more likely to develop breast cancer than African American women, although African American women are more likely to die from the disease. 
Among women under the age of 45, however, African Americans are more likely to develop breast cancer, while Asians, Hispanics and native American women are less likely to both develop and die from the condition.
Some past studies investigating the reasons behind variations in breast cancer incidence and survival between ethnicities say it may be explained by differences in exposure to breast screening and examination, as well as the likelihood of receiving the required care after a breast mass is found.
However, the researchers of this latest study - including Dr. Javaid Iqbal of Women's College Hospital in Toronto, Canada - say more and more research is pointing to biological factors as a potential explanation. 
"The growth rate and metastatic potential of small-sized breast cancer tumors may vary between women due to inherent differences in grade, receptor status and other or unknown pathological features," the authors explain.

Breast cancer data analyzed by eight race/ethnic groups

For their study, Dr. Iqbal and colleagues set out to identify the variation in early-stage breast cancer diagnosis (stage I) by race and ethnicity and determine whether biological differences in tumor aggressiveness play a role in these variations.
Fast facts about breast cancer
  • Breast cancer is the second leading cause of death among women in the US, although death rates from the disease have been declining since 1989
  • Around 2 in 3 invasive breast cancers are found in women over the age of 55
  • Around 5-10% of breast cancers are hereditary, primarily caused by mutations in the BRCA1 and BRCA2 genes.
Using the Surveillance, Epidemiology and End Results (SEER) database, researchers assessed the data of 452,215 women who had been diagnosed with invasive breast cancer between 2004 and 2011. After excluding women with stage 0 or unknown breast cancer, the team were left with 373,563 women in their analysis, who they followed for an average of 40.6 months.
The researchers assessed the biological aggressiveness of small-sized tumors (2 cm or less) across all eight races and ethnicities identified: non-Hispanic white, Hispanic white, black, Chinese, Japanese, South Asian (Asian Indian, Asian Indian or Pakistani, Pakistani), other Asian (Filipino, Thai, Vietnamese, Korean, Kampuchean, Laotian, Hmong) and other ethnicities (including Native American and Alaska Native).
By race/ethnic group, the team also assessed the women's risk of being diagnosed with breast cancer in the early stages of the disease, their likelihood of being diagnosed at a later stage and their risk of death from the disease.

Japanese women more likely to be diagnosed with early-stage breast cancer

The results of the analysis revealed that Japanese women were much more likely to be diagnosed with breast cancer at stage I than non-Hispanic white women; 56.1% of Japanese women were diagnosed at stage I, compared with 50.8% of non-Hispanic white women.
Around 37% of black women and 40.4% of South Asian women were diagnosed with breast cancer at stage I, meaning they were more likely to be diagnosed with the disease at a later stage than non-Hispanic white women.
The risk of death from stage I breast cancer in the 7 years after diagnosis was higher among black women than both non-Hispanic white women and South Asian women, with 6.2%, 3% and 1.7% dying from the condition, respectively.
In addition, the researchers found that black women were much more likely to die from small-sized breast cancer tumors than non-Hispanic white women, at 9% compared with 4.6%.
They say the differences in diagnosis and survival of stage I breast cancer among race/ethnic groups may be explained by variations in biological variations in tumors, including lymph node metastasis, distant metastasis and triple-negative behavior (in which cancer growth is not driven by estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2 (HER2).
The team explains:
"In support of this hypothesis, a black woman with small-sized breast cancer tumors was more likely to present with lymph node metastases, was more likely to have triple-negative cancer and was more likely to present with distant metastases than a non-Hispanic white woman with tumors of similar size."
The researchers note, however, that socioeconomic status, access to and use of health care, adherence to treatment and presence of additional health conditions may have also contributed to variations in diagnosis and survival of early-stage breast cancer.
The team notes several limitations to their study. For example, the SEER data used for the research only represents 28% of the US population, so the results may not be generalizable to all women of different race/ethnic groups in the US.
In addition, they point out that the women in the study may have been subject to different treatments and had various other illnesses, which may have influenced the results. Data on this information, however, was not available.

'Unprecedented opportunity' to provide high-quality care despite race, ethnicity

In an editorial linked to the study, Dr. Bobby Daly and Olufunmilayo I. Olopade, both of the University of Chicago, say that in order to effectively treat breast cancer going forward, there needs to be a better understanding of the drivers behind the variations of diagnosis and survival between race/ethnic groups.
They state, however, that there is an "unprecedented opportunity" to deliver high-quality breast cancer treatment regardless of a woman's race or ethnicity:
"Access to the use of genetic or molecular markers to guide choice of targeted therapy and reduce the costs of care can be made more equitable. For women with triple-negative disease, access to prompt diagnosis and initiation of chemotherapy can be lifesaving because these tumors metastasize early."
"Closing the survival gap will only occur once health care leaders initiate system changes that improve access to high-quality care along with a more comprehensive study of breast cancer biology through inclusion of a substantial number of minority patients in 'omics' research and in clinical trials," they add.
Medical News Today recently reported on a study published in Nature Communications, in which researchers from the UK revealed the discovery of the gene that drives triple-negative breast cancer.
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Friday, December 19, 2014

Bye Bye My Little Love

Goodbye my sweet Gypsy boy
On December 13, just one year and nine days after I lost my beloved Tigger. I had to put my Gypsy boy down. Within five short weeks, his health deteriorated rapidly. It kicked-off with a seemingly harmless virus that gave him a fever and sniffles. Suddenly, his frenetic outbursts of energy, his morning jumps at the front door combined with raucous meows to get out and discover the day gave way to listlessness. I threw him a toy and he just stared at it. Clearly, there was something wrong.

The vet said, no worries, he just caught a virus and put him on antibiotics for 10 days as a precaution. During that time, his weight spiraled down inexplicably and his spunky spirit turned to lethargy. But let's not go into the end of his life just now. Let's talk about the beginning.

Gypsy is my fourth cat that I had to let go. They all have their special places in my heart. But he  was the most feisty one--the scrappy survivor that I discovered living homeless outside during a bitter winter.

His rescue story is perhaps the most heartbreaking of all my cats.  In February 2008--the month before I found out I had breast cancer--I had seen him roaming through the neighborhood. The condo association was about to contact Animal Control to capture him in which case he would have surely been euthanized. That association seemed like the Wicked Witch of the West, out to kill my little brown "Todo" of a cat.

With two rescue cats already in my care, I knew it wasn't a good idea to take in a third, but that spunky little brown tabby knew just what to do to capture my heart. He snuck inside my garage to stay warm one night, and before I knew it,  I created a sanctuary for him there to survive the winter. I made a bed for him and kept food and water there. I kept the garage door cracked open at the bottom just enough for him to slink inside. By the time spring arrived, he would rush up to me and swirl around my legs until I picked him up. He would purr loudly and look lovingly into my eyes. This was no feral cat. He had been neutered, so at one point in his life, at least someone cared.

I announced to all the neighbors on the block that this little brown cat with the crooked ear was mine, so no one better mess with him, much less call Animal Control. Besides, he had turned out to be a working cat by going on midnight runs killing pesky mice and rats. One morning, I found two fat rats lined up neatly dead at the doorstep. Gypsy knew he had to earn his keep. When I took walks, he strutted aside me like a dog. He greeted everyone that stopped to chat by swirling around their legs and giving them a hardy meow. When Gypsy accompanied me to get the mail one day, even the grumpy condo manager mumbled: That cat is really something.

During summer, my neighbor upstairs began renovating her kitchen. When her contractor saw my newly-acquired pet he proclaimed: "I recognize that cat because of his crooked ear! He lived in the house next door to me where the residents had more than 20 cats. They were evicted and rumor had it that they loaded all the cats into a truck and threw them out randomly throughout Fairfield County." My little brown tabby had come from 15 miles away, which is why I decided to name him Gypsy.

Gypsy was truly an outdoor cat. To try and lock him up inside what have crushed an essential part of his spirit. Most of the time, he was content to just sit at the end of my sidewalk like a guard dog and meow at everyone that walked by. If I was down at the pool, he would slide under the gate and saunter toward me meowing loudly with each step. The kids ate it up and asked if they could pet him, what his name was and generally fawn all over him. Their dripping wet suits and hair didn't faze him because he actually loved water. He would always spoon water with his paw in order to drink it.

One of my cat-loving neighbors proclaimed Gypsy had some Mainecoon blood in his pedigree because of his water-drinking habits, his constant meowing, his big paws that looked like snow shoes, his fur color and texture and the way he followed me like a dog. I googled the cat breed, and had to agree with him. He didn't have the tufted ears and bushy tail, but he had everything else.

When it got cold in Autumn, I decided it was time to bring Gypsy inside the house and meet "the boys"--Tigger and Mango. Tigger had pressed his nose on the window pane every time he saw Gypsy outside the front door. Once they met face to face, they bonded instantly. Who knows why they loved being together so much. What I do know is that Gypsy greatly enriched the last five years of Tigger's life with his big, loving heart.  They spent every night sleeping together on the living room ottoman and groomed each other for hours on end.

On two occasions when Tigger accidentally got outside, Gypsy hunted him down and brought him back home. Gypsy was the one that lead me to Tigger as he lay dying of a heart attack in my bedroom. From the moment Tigger died, Gypsy refused to jump on the ottoman he shared with Tigger.  It was too painful for both of us to look at that piece of furniture, so eventually I stored it away.

Gypsy tried in vain to cuddle up with Mango in an effort to replace that lovable friendship that was now lost from his life. But Mango would have none of it. I could see over the past year how a little light went out from Gypsy's soul when he lost his best buddy Tigger. He missed him terribly.

On December 1st,  I spent $200 on blood work to find out why Gypsy was losing weight, which yielded no answers to his condition. I refused to pay an additional $350 for a sonogram. So the vet prescribed two weeks of prednisone  to see if it was just irritable bowel syndrome. I also bought prescription, high-calorie food that cost $45 for a bag to see if he would gain weight and get back to his old self.

It didn't work. He ate all the time, and yet he kept wasting away. He would have a good day and then the next morning I would see he had vomited almost everything he ate. During the last two days of his life, if I touched his rear end, he would cry out in pain.

But during those last three weeks,  he would climb up on my chest every night as I lay in bed and fall asleep.  Occasionally, he would wake me up by softly by tapping my face with his paw. For the first two weeks he purred while his head nestled his head under my chin. But the last two nights of his life, that even stopped.

I knew it was time to let him go when he struggled to jump off my bed and limped into a dark corner of my closet. He just stared at me with this sad, forlorn face. It was as if he was saying: "What are going to do about me? I am sick and tired of this."

When I picked him up out of that corner to take him him on his final journey, he felt like a rag doll--limp and barely alive. During the drive to the vet he uttered not one meow, which is unusual for this cat, because he was always quite loud and verbal. Instead, he pushed his head into my hand every time I touched him in the mesh carrier. At one point in the car, he looked up at the sunlight in the sky and I saw a look of contentment.

During our 35-minute ride, I told Gypsy rescuing him was one of the best decisions I had ever made. I explained that very soon, he was about to join his best buddy Tigger. And that was surely something he could get excited about--especially since his life had been full of misery and pain over the past three weeks.

As the vet sprawled him out on a cold, metal table during Gypsy's final moments, I looked deep into his eyes and said thank you for all the wonderful memories he gave me. I kissed his head and told him how much I loved him and how much I would miss him. And then I said, go ahead, it's time to join Tigger now. Won't that be fun?  With that, he gently and peacefully slipped away.

Gypsy and Tigger happy together in heaven
It seems that it is no coincidence that Gypsy died practically a year to the day that Tigger passed away. Of course, I miss Gypsy terribly. But I feel good that I acted decisively and decided to put him down swiftly rather than drag out his pain for weeks. Two days before he died, he had a good day, I wanted him to leave on a high note. The day before he died, he was in misery. I did the right thing.

It's only been six days since he's been gone. My last remaining rescue cat hasn't missed him a bit and clearly feels lucky that after all these years, he finally has me all to himself again.

Mango is 13 or 14 years old now. I know our days are numbered. And I treasure every one of them with him. But just like all my other cats, no one of them will be like my precious Gypsy boy, that I rescued after being thrown off a truck. Thanks, my little love, for seven years of great memories.

Thursday, November 27, 2014

Happy Thanksgiving--Now Turn Off Your Phone

Thanksgiving in 2014
I believe I can speak for most people when the thought of losing or breaking my iPhone, iPad or Mac laptop would give me a huge meltdown. I know this to be true because it has already happened on a few occasions. I have stood paralyzed by panic during such moments and wondered how we ever got through life without these gadgets.

That said, there are some days when you just have to bite the bullet and turn off the technology. Yes, that means disconnecting with the newsfeeds of your choice, the constant twitter and Facebook updates--everyone's got their own cyberspace addictions.

Today, you gotta just shut it all down. Thanksgiving is one of the few holidays in the United States that is not tied to any religous observance. It was created soley by our American forbearers--The Pilgrims--to gather family and friends together in order to catch up, laugh, eat, bond and give thanks to all that we have.

So if you dare bring your iPhone to the dinner table today, consider this photo-
shopped Norman Rockwell painting and ask yourself: What's wrong with this picture?

Tuesday, November 25, 2014

Guest Post

This post is courtesy of breast cancer blogger Alex. Visit her blog at

Ask for Help and the Cancer Blues
I remember the day that I picked up the phone. I had managed a hell of a ride. Every decision came like rapid gunfire and as terrified as I was, the decision had clarity and reason. Every decision had reason. Sugery, more surgery, changing surgery, complications, chemo, genetics, hysterectomy, BRCA results to my family…….then I felt vulnerable, scared and uncertain. That is simply not a feeling that I am comfortable with and did not own. The fear and significant brain fog was compounded with impending return to work and stress.  Not surprisingly, I felt edgy, fragile and alone. I picked up the phone. I wanted to find someone just like me – I needed to know I could follow some footprints; that someone would have done this but I came up with nothing. I had picked up that 1000lb phone to be left with all I started with. I was as average as my disease, there were no mentors for me.
My Art Therapy took my grief to the paper and I had to find my own way to wellness in the confusing world of being on both sides of medicine.
But what a world it turned out to be. How powerful to be the change. How fascinating to work out what the mind does to find it’s strength again when, after so many hits, you have to find the crack of light to believe good will happen.
So as you have found us, I want you to understand how to find yourself again after cancer. We have all reached out for help and are changing how this cancer journey is understood. It is not only the obvious times that you ask for help – the ride to chemo and taking kids to school. Look closer at what the Mirror Ball 2014 calls the Cancer Blues:
Just Ask
When you can’t recognize the person in the mirror  - we’ll be there
When your body is not ready to buy new clothes – we’ll be there
When bills keep coming and you cannot work – we’ll be there
When all the treatment has finished but you are not better – we’ll be there
When chemo fog knocks down your last bit of pride – we’ll be there
When nausea hits as soon as you are vertical – we’ll be there
When you are jealous of those who don’t get it – we’ll be there
When your calendar of fun gets erased  - we’ll be there
When you are in the scanner, eyes shut, just breathing – we’ll be there
When you have to tell your kids, and they get it – we’ll be there
When fatigue hits like a wall of surrender – we’ll be there
When pain invades your thinking – we’ll be there
When it doesn’t end at the chemo bell – we’ll be there
Those awkward wig moments in the wind – we’ll be there
When your kids don’t want to hug the disease – we’ll be there
- See more at:

Wednesday, October 22, 2014

Looking Back

Every October I make sure to participate in at least one breast cancer event. Sometimes its simply a cocktail party fundraiser. Other times its a breast cancer walk. If my memory serves me correct, I've participated in six breasts cancer walks so far--four Susan G. Komen walks and two community walks--the most recent being the Seymour Pounding The Pavement For Pink 5K this month.

Elin Hilderbrand, Novelist
I do these things every October so that I never forget that back in 2008, I was battling breast cancer in a fight for my life. Today, in almost every way, life is back to normal. But then I hear of someone I know or admire who is just beginning their breast cancer battle.  My knee-jerk reaction is to reach out and assure them that the odds are on their side. That there will come a time when they'll be just like I am now--back to normal.

One such person who is currently in the throws of numerous breast cancer surgeries is a favorite novelist--Elin Hilderbrand. Almost every summer, I settle in by the pool or beach to read her stories that are always set in one of my favorite places--Nantucket. I love reading her books such as Barefoot, Summerland, The Castaways. It is a guilty pleasure to live vicariously through her characters entangled in romances and frought with challenges as they romp the beaches of this idyllic New England island.

Every time I see an update on her facebook page about yet another surgery and another complication because of her treatment, I feel her pain. And yet she refuses to let it paralyze her. She carries on, getting back to her desk and pounding away at her next novel, just days after getting out of Mass General Hospital.

It inspires me to soldier on whenever I am faced with daunting challenges today. I remind myself that by the grace of God, I am armed with good health now. So there's no excuse for ignoring unpleasant issues that must be dealt with.

I was very fortunate because I was cocooned in a supportive environment when I was battling breast cancer. Now that I am well, there are less people around to cheer me on when things get tough. That's when I realize how important it is to get outside myself and help another breast cancer survivor so I  don't get pissed off about having to deal with life on life's terms. I have to remind myself that I fought one hell of a battle. After that, whatever comes my way should be easier to face head-on.

So Elin, do exactly what you are doing now. Follow your doctors orders, get through your treatment and just keep on writing those great novels. Someday when you look back, you will realize today's
setback is merrily a bump in the road.

Friday, September 19, 2014

And So There Must Come An End

Blogger's Note: This piece was featured in UK The Huffinton Post today and thought it fitting for all of us who have battled cancer--Marcy Bruch
Charlotte Kitley

Charlotte has blogged on The Huffington Post UK since 2013 and sadly passed away on Tuesday 16 September from bowel cancer. She wrote one final post that she wished to share with all of her readers. We are honoured to offer it to you here.
I've always been a good planner. I like lists and tick sheets, to-do notes and objectives. I'm very good at starting things, but honestly, I am also easily bored and quickly lose interest once the original excitement passes.
I haven't had the luxury of being allowed to be bored of having cancer. It isn't something you can just give up if you don't fancy doing it that day. There isn't a switch you can chose to turn off one day from the next. At least not for me. From my first day as a cancer patient, I have attended every test, scan and appointment. I have tried every treatment offered, from the standard medical therapies, to eating oiled cottage cheese, having acupuncture and juicing kale. Cancer has become our life. Holidays, haircuts and helicopter lessons have all been timed around good or bad chemo weekends. Danny and Lu, unwittingly as innocent by-standers have had their childhoods protected but also dictated by my various regimes. This is all they have ever known and, I hope, have still managed to turn out to be pretty good, well-rounded, loved and treasured children.
The innocence that we have protected them from has now had to be revealed. Following my birthday, I started to feel 'unwell'. We 'popped' to hospital where the usual set of tests were carried out. Unfortunately, when combined with a recent scan, the results were nothing short of devastating. We were no longer looking at a month by month action plan with a couple of months buffer at the end. I was given days, perhaps a couple of weeks to live. I wasn't expected to leave the hospital, but somehow, have managed to pull it out of the bag at the last moment and return home, to spend what little time I have with my darling children and loving husband.
As I write this, I am sat on the sofa, relatively pain-free and busy doing my little projects, sorting out the funeral and selling my car. We wake up every morning, grateful I can have a cuddle and kiss my babies.
As you read this, I will no longer be here. Rich will be trying to put one foot in front of the other, to get by, a day at a time, knowing I will no longer awake next to him. He will see me in the luxury of a dream, but in the harsh morning sun, the bed will be empty. He will get two cups from the cupboard, but realise there is only one coffee to make. Lucy will need someone to reach for her hairband box, but there won't be anyone to plait her hair. Danny will have lost one of his Lego policeman, but no one will know exactly which one it is or where to look. You will look for the latest update on the blog. There won't be one, this is the final chapter.
And so I leave a gaping, unjust, cruel and pointless hole, not just in Halliford Road, but in all the homes, thoughts and memories of other loved ones, friends and families. For that I am sorry. I would love to still be with you, laughing, eating my weird and latest miracle food, chatting rubbish 'Charleyisms'. I have so much life I still want to live, but know I won't have that. I want to be there for my friends as they move with their lives, see my children grow up and become old and grumpy with Rich. All these things are to be denied of me.
But, they are not to be denied of you. So, in my absence, please, please, enjoy life. Take it by both hands, grab it, shake it and believe in every second of it. Adore your children. You have literally no idea how blessed you are to shout at them in the morning to hurry up and clean their teeth.
Embrace your loved one and if they cannot embrace you back, find someone who will. Everyone deserves to love and be loved in return. Don't settle for less. Find a job you enjoy, but don't become a slave to it. You will not have 'I wish I'd worked more' on your headstone. Dance, laugh and eat with your friends. True, honest, strong friendships are an utter blessing and a choice we get to make, rather than have to share a loyalty with because there happens to be link through blood. Choose wisely then treasure them with all the love you can muster. Surround yourself with beautiful things. Life has a lot of grey and sadness - look for that rainbow and frame it. There is beauty in everything, sometimes you just have to look a little harder to see it.
So, that's it from me. Thank you so much for the love and kindness you've shown in your own little ways over the last 36 years. From the mean girls in the playing fields who pushed me into the stinging nettles aged six to the bereaved husbands who in the last week have told me what their wives did to help prepare their young children and everyone in between. They and you have all, in some small way helped me become the person I have been.
Please, now use that love for me and pass it to Rich, my children, family and close friends. And when you close your curtains tonight, look out for a star, it will be me, looking down, sipping a pina colada, enjoying a box of (very expensive) chocolates.
Good night, Good bye and God bless.
Charley xx