Sheryl Crow for Senate

Began today reading the news. Ouch. Bad idea. Can it really be that bad out there? Seems that way. Hope Obama can make as much of a difference as Sheryl Crow.

Sheryl Crow Sheryl Crow. Besides looking cool in print Sheryl is a hero to many women and most don't even know it.

So many woman who begin this journey thru surgery, chemo, radiation wonder how they will make it. It can be a long journey - a year or more- and may feel like three. But like most journeys it will end.

And here is where Sheryl (and Lance-but this ain't about Lance) shines on like a crazy diamond. Sheryl used the experience to focus on herself when need be, to get better, and then focused on everyone else. She became and remains the perfect role model for breast cancer patients.

Sheryl allowed herself to become the image of strength and hope and courage for woman. She went thru treatment without a public wimper and then went about her business. But now her business is helping in the fight. And she helps in so many different ways. Google her.

If you do google her you will find a ton of stuff about her helping and helping. City of Hope? She's with em. Changed her music after her experience. She basically let it shape her and she used it for the good - for herself and others.

I usually don't expound like this on this blog. Usually I offer advice. The only advice I can offer here is to think of Sheryl if you have breast cancer and I think it will help you get thru it and help you think of others at the same time.

Oh, and if I have to offer advice today it would be to go see "The Boy in the Striped Pajamas" and "Slumdog Millionaire".

Don't delay

Delay is usually not good. We all do it however. I"m a renown procrastinator. But some things we ought not delay.

Breast cancer treatment is one of those things we ought not delay. We kinda know that --I mean it makes common sense. And we have evidence in some other cancers that delay does make a difference. We know delay makes a difference in cervical cancer and head/neck cancer.

Well, a new study shows that delay or incomplete radiation treatment makes a difference to woman in terms of how they will ultimately do.

An analysis of the National Cancer Institute's cancer registry has found that delaying radiation therapy for women with breast cancer can lead to increased recurrence of the cancer.

The findings revealed that as many as one in five older women experience delayed or incomplete radiation treatment following breast-conserving surgery, and that this suboptimal care can lead to worse outcomes.

Delaying treatment by eight weeks or more significantly increased the odds for recurrence.

Patients whose radiotherapy was delayed by 12 weeks or longer were four times more likely to have a recurrence

Women who had incomplete radiation treatment - those who underwent fewer than three weeks of the typical five-to-seven-week regimen - had a higher rate of overall mortality.

As Ben Franklin used to say, "God heals and the doctor takes the fee". Wait a minute, wrong quote.
Ben also used to say, "You may delay, but time will not."

To be sure I know that some people have delays that are beyond control.

But if at all possible let us make a promise to eliminate all the kinda urgent but not really, I have a trip planned, but we bought plane tickets, I've never seen Mongolia, it's cold out there kind of excuses.

Breast cancer in the news

Once again we report some of the more interesting tidbits found in the news in the last 2 weeks.

Here is a rather alarming and well done study. Researchers at Univ of Southern California found that eating 1/4 of a grapefruit or more per day was associated with a 30 percent increase in breast cancer risk in certain postmenopausal women. The increased risk from eating 1/4 or more of a grapefruit per day was seen in women who never took hormone therapy to treat menopausal symptoms as well as in women who were taking estrogen alone or combined estrogen and progesterone. Breast cancer risk was also higher in the thin women who ate grapefruit than it was in the overweight women who did. The probable mechanism is that grapefruit increases estrogen levels - increased estrogen is a known risk factor for breast cancer.

Even Dr. Susan Love says the study is well done. She does not recommend abandoning grapefruit but cautions it may be wise to cut down intake. This is a rather strong recommendation from a very well respected authority. Most readers know I'm generally wary of the multitude of reports of this type. There are just so many. But the grapefruit report has gotten my attention. Be careful of the well known grapefruit diet!


US scientists have now said that women should think twice before taking the herbal therapy black cohosh. The report indicates the herb can increase the chance of breast cancer cells migrating from the breast to the lung.


In a report on their findings, published in the journal Cancer Research, they said: "These results suggest caution for black cohosh use in women with and without breast cancer."
Black cohash has been popular as a natural treatment of menopausal symptoms. I think the popularity is about to go down!

And now for some good news!

As reported in the journal Breast Cancer Research.

Researchers followed 32,269 post-menopausal women for eleven years and found that vigorous exercise was protective against breast cancer - independent of body weight.

Vigorous activity was defined as anything from strenuous sports such as running, biking up hills, and aerobics to taxing housework such as scrubbing floors, chopping wood or heavy yard work.
Fascinatingly, non-vigorous activity was not protective (non-vigorous activity included walking, light housework, leisure biking).

One of the takeaways of this article is woman may want to think about increasing the intensity level of their exercise. But I make this comment with hesitation. The increase in injuries, accidents, heart attacks etc may negate the positive effects for some woman. That said, if a woman is in good general health and has a doctors OK then the increased intensity should be good for women on many levels. Just do it!

That's it for this week in the news. I find the above particularly interesting because all three of the above are popular foods or activities. But more importantly they are things women can do right now - today - to lower the risk of breast cancer.

Mammosite and you

So many things we have to decide when it comes to treating breast cancer with radiation therapy. It used to be so simple. After lumpectomy a woman underwent 6 weeks of daily radiation and that was that.

Oh, things have changed. And mostly for the better. But like everything else there is always more to the story. So, here is the story on partial breast radiation and mammosite.

Firstly, it is in widespread use and remains controversial. For select women it is an excellent option - but only if the patient understands the controversy, risks, and benefits and then decides it is for her.

What is the controversy? Read the New York Times recent article which does a great job of explaining. Read it here.

Basically, the track record is not long. It is based on data from few women compared to the standard treatment. And the device was "fast tracked" by the FDA which means it was not determined if it is actually effective at treating breast cancer. The fast track approval means the Mammosite was actually approved because it performed as advertised - it delivered radiation to the resection cavity. It was not approved because it was proven to be better or equal to the standard 6 week course of radiation.

Secondly, it is not for everyone. It should be offered to the selection of women who meet the strict criteria. This prevents placing women at increased risk of local failure, skin damage, lung/rib damage when a safer alternative is available.

Partial breast techniques include mammosite, other implant techniques/devices, external beam with 3D or IMRT and all should only be delivered in an institution with expertise and perhaps in a study setting. The informed consent should make sure the patient clearly understands the procedure is controversial, not tested in the long term, and the side effects may be differnet than the standard 6 week course of radiation.

On the other hand, for the women who are good candidates for mammosite it can be a great idea. I've used the mammosite personally with many women and generally it is well tolerated and side effects minimal.

The leaders in partial breast techniques in the country are doing a great service to women who may need or want this approach. But like anything else in this world - there is more to the story than meets the eye. Please read the NY Times article for more info - here.

Turning Heads - the book to give away

I"m a doctor and photographer. It is just what I am. Rarely do the two meet in any artistic way. Oh sure, there is the occasional moment or two if I bring my camera to work and see something cool. Click on that cool link and you'll see a cool work photo. But few and far between.

Then one day about 5-6 years ago I got a call from Jackson Hunsicker. Jackson is just one of those people you want to know. She is funny, bright as can be, very cool, fun to be with, well, you get the idea.
Jackson's idea was to gather 2 waves of people to do something remarkable. One wave was bald women of every size, color, ethnicity, and strength. These women were all breast cancer patients who lost their hair from chemotherapy. The second wave of people were photographers. And I mean great photographers - famously great photographers.

Jackson set out to publish (on her own) a remarkable book about bald woman.
Here is the official link to this remarkable book. Check it out right here.


The purpose of Turning Heads is to show the world that life does not stop with a cancer diagnosis. That bald women can be strong, vital, and beautiful people with full lives.

The book succeeds wildly. Firstly, because it is a brilliant idea - a creative force.

Secondly, the photos are works of art taken from 59 different world class, I wish I could shoot like them, photographers. You've heard of a lot of them. You may own or collect some of their other works. You should collect and own this book. The photos are that good. Who are these photographers?

How about Stephen Wilkes, Annie Wells (Pulitzer winner), Joyce Tenneson, Greg Gorman, and Lauren Greenfield to name a few. What more do I really need to say with names like these gracing the pages.

I could say the book only cost $21.86 at Amazon and please tell everyone women to buy one for a friend. Or tell your oncology friends to stack them for giveaway in the waiting room.

Actually, every medical oncologist, breast surgeon, radiation oncologist, psychologist, should keep a stack in the waiting room to GIVE to patients. It would not really make a dent in their yearly marketing budget and be far more effective than, say, a bad holiday gift basket that is gone in a day.

Bald patients see this book and smile. They understand the message is meant for them and it is a positive, loving, beautiful message. Click on those links above, please.

Dr. Susan Love and research

While I was writing the post on the robot MRI (see below) I noted that Dr. Susan Love has several research projects within her foundation. I thought I would post on some of these because of their importance.

While the robot MRI might be years in the future these studies are open now to qualifying women. Here is one that is quite intriguing in that a small amount of chemotherapy is injected into the tumor area after diagnosis. Read on and please visit Dr. Love's blog and main page.
http://www.dslrf.org/endingbc/content.asp?L2=1&L3=7&L4=4&SID=292


Effect of Intraductal Therapy of DCIS with Pegylated Liposomal Doxorubicin (PLD) on Pathology and Biomarkers: A Presurgery Study
(Currently Recruiting)
The Dr. Susan Love Research Foundation is looking for 30 women recently diagnosed with ductal carcinoma in situ (DCIS) to take part in a groundbreaking new research project. Study volunteers will need to have been diagnosed with a core needle biopsy or with ultrasound and not yet have had surgery. The study involves having a small amount of a chemotherapy drug injected through the nipple into the affected milk duct. The volunteer will be observed for a couple of hours, and then go home, with a surgery date set in the next four to six weeks. Prior to surgery, ductal fluid will be aspirated and an MRI will be performed. The tissue removed during the surgery will be examined to see what effect the drug had on the DCIS. It is hoped that the findings from study will provide the data necessary to support the launch of a nationwide clinical trial of intraductal therapy for the treatment of DCIS.

This research is being conducted in collaboration with Ellen Mahoney, MD, St. Joseph's Hospital in Eureka, Calif., and the Humboldt Community Breast Health Project. Research participants will need to travel to Eureka, Calif., for the treatment and the surgery. This study was funded by the California Breast Cancer Research Program (CBCRP). Please call Ashley Casano at (310) 828-0060 Ext. 32 or send her an email for more information.

Future Breast cancer treatment

I agree with Dr. Susan Love. The ideal way to cure breast cancer is to prevent it. And thru her pioneering efforts we will do just that. In the meantime we still have to take care of the thousands of women who are diagnosed each year.

One area where we have made great strides is in reduction of side effects and amount of breast tissue treated. For instance, mastectomy used to be the only option for most women. Now, mastectomy is reserved for those who cannot (or will not) undergo lumpectomy and radiation. We have also learned that a sampling of lymph nodes is just as good as a full lymph node surgery for most women. And that partial breast radiation is perfectly suited for some women instead of whole breast radiation. That is a lot of improvement over a short period of time.

I do not usually comment on the "latest and greatest" news item--but this one caught my attention. It is about a robot within an MRI that can detect and destroy breast cancer cells. The only catch. Not ready for prime time until some time in the future. But it is intriguing.

Here is the link
http://gizmodo.com/5062325/robot-prototype-finds-attacks-and-kills-breast-cancer-cells

It is intriguing because this kind of thinking and technology is what leads to further reductions in side effects for women. And in lessening the trauma of breast cancer treatment.

I don't know if a robot can do everything the article says it can. But I do know that just a few years ago the words partial breast radiation, lumpectomy, sentinel lymph node were unknown to most of the world.

So until Dr. Love's vision of prevention of breast cancer is realized we still have to advance our ability to treat women with more finesse and less side effects. We are very good at this.