Women warned of post-mastectomy risks

Reconstructive surgery can numb breasts, cause pain and become potentially perilous

Reconstruction, according to The New York Times, can lead to complete numbness in the breasts.

An article by Roni Caryn Rabin yesterday contends that doctors often fail to warn patients that although reconstructive surgery following breast cancer might save their nipples and keep their breasts natural-looking, they afterwards may be unable to "sense the slightest touch of [their] breasts, perceive warmth or cold, feel an itch if [they have a rash or pain if they bang into a door]."

And nipples may "lack any feeling."

In addition, sexual arousal may not be restored.

Rabin's story indicates that "plastic surgeons performed more than 106,000 breast reconstructions in 2015, up 35 percent from 2000."

Most often, they use a woman's belly fat to create a new breast.

The lack of sensation "is potentially dangerous," the story charges. "Women who have had mastectomies and reconstructive surgery have sustained severe burns on the breasts from heating pads, hair dryers, curling irons, sunbathing and overly hot showers."

Dr. Andrea L. Pusic

And although the surface of the skin may become numb, pain underneath still may radiate everywhere: 

The Times piece notes that some women have tingling sensations after the surgery, others have "debilitating pain."

The "post-mastectomy pain syndrome," the story maintains, "is fairly common, affecting anywhere from 25 percent to 60 percent of mastectomy patients, according to published studies."

The Times article quotes Dr. Andrea L. Pusic, a plastic surgeon at Memorial Sloan Kettering Cancer Center who specializes in reconstruction and studies patients' post-surgery quality of life, as admitting that "our focus has been on what women look like. What it felt like to the woman has been a kind of blind spot in breast surgery. That's the next frontier."

Reconstruction and other post-surgery treatments are dealt with in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Need for caregivers growing while supply shrinks

Volunteer U.S. caregiving force of 40 million is in grave danger, doctor asserts in N.Y. Times

The American reliance on a volunteer caregiving force may be unsustainable.

Why?

Because the demand for caregivers is growing — due to longer life expectancies and more complex medical care, according to a story in The New York Times by Dr. Dhruv Khullar, resident physician at Massachusetts General Hospital in Boston — while the supply is shrinking, "a result of declining marriage rates, smaller family sizes and greater geographic separation."

That, Khullar indicates, is what members of the National Academies of Sciences, Engineering and Medicine think.

His piece notes that "some 40 million Americans…help a parent, grandparent, relative or neighbor [every day] with basic needs: dressing, bathing, cooking, medications or transportation."

Dr. Dhruv Khullar

And it suggests the AARP and National Alliance for Caregiving believe "the typical family caregiver is a 49-year-old woman caring for an older relative — but nearly a quarter of caregivers are now millennials and are equally likely to be male or female."

A third of them apparently provide more than 21 hours of care weekly.

Mostly, they're unpaid, "but the economic value of their care is estimated at $470 billion a year — roughly the annual American spending on Medicaid."

About a third of the total also have full-time job, and a quarter work part-time.

The strain on caregivers is evident, however.

Especially when it comes to finances.

Sixty percent of those caring for older family members, the Times story says, end up cutting their work hours, taking a leave of absence or making other career changes.

In addition, "family caregivers are more likely to experience negative health effects like anxiety, depression and chronic disease."

One study Khullar cited found that those caring for a disabled spouse and experiencing mental or emotional distress "were 63 percent more likely to die within four years than noncaregivers."

His article says one way of helping caregivers is to bolster counseling and support services available to them. Another way would be to develop "respite programs to temporarily relieve them of their responsibilities."  

Details about overcoming such stresses and distresses can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at caregiving.

2,014 women with mastectomies studied

Radiation after some breast reconstructions can cause extra complications, report says 

Radiation might dramatically affect the results of breast reconstruction.

According to a recent report on Breastcancer.org, new research "suggests that radiation after implant reconstruction seems to cause more complications than radiation given after autologous reconstruction [rebuilding the breast with tissue from your own body]."

The study, presented at the annual San Antonio Breast Cancer Symposium, "looked at medical data and collected patient reports on reconstruction outcomes from 2,014 women who had mastectomy and breast reconstruction."

Two years after radiation was completed, 39% of women who'd undergone implant reconstruction had at least one complication — compared to 26% for those who'd had autologous reconstruction.

Worse yet, the study showed radiation was "linked to more than doubling the risk of complications" after the implants but was "not associated with a higher risk of complications" in women who'd undergone the other treatment.

Complications included "infection at the surgery site, hematoma (collection of blood outside blood vessels), capsular contraction, and other problems."

Those with implants who'd been treated with radiation also were less satisfied with their results than those who didn't get radiation, the study indicated.

Dr. Reshma Jagsi

Dr. Reshma Jagsi, lead author of the study and deputy chair of radiation oncology at the University of Michigan, contended that women who planned to receive post-mastectomy radiation therapy needed to be informed of the "significant impact" the study found regarding radiation and implant reconstruction. 

And conversely, she said, "those who plan to pursue autologous reconstruction…may derive some reassurance" from the statistics.

Dr. Marisa Weiss, Breastcancer.org founder, added that "one thing I recommend as a breast radiation oncologist who deals with this issue all the time is to make sure the implant you get is fairly close to your original size." The problem with a bigger size, she noted, is that the skin has already "lost a lot of its blood supply with mastectomy, it's been stretched, it's maybe been subjected to chemo, it's not the happiest camper on the block."

After mastectomies, radiation normally is recommended if the cancer is about two inches long, if it's spread to four or more lymph nodes, if it's spread to the skin, or if cancer cells are found in the rim of tissue around the disease (the margins).

Post-surgery feelings of patients are addressed in detail in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

No need found for an added diagnostic tool

In diagnosing male breast cancer, ultrasound isn't better than mammography, study says

Ultrasound imaging apparently doesn't provide any more information than mammography when it comes to men's breast cancer.

A new study's conclusion, according to an article on the Breastcancer.org website, is "that mammography should continue to be the main diagnostic tool for detecting breast cancer in men with symptoms."

It originally had been thought ultrasound might offer additional benefits.

The study, whose findings were reported at the recent annual meeting of the Radiological Society of North America, had looked at the records of 360 men above the age of 25 who'd had symptoms that included "feeling a lump, pain, and nipple discharge."

Dr. Eric Blaschke

Dr. Eric Blaschke, one of the study's authors, was quoted as saying, "We didn't find that use of ultrasound in male breast cancer was useful in detecting new cancers."

Some 2,470 men are expected to be diagnosed with breast cancer in 2017, the story noted. "For men, the lifetime risk," according to the website, "is about 1 in 1,000."

Risk factors for men, the site indicates, include growing older (the average age of those diagnosed is about 68), having high estrogen levels, having Klinefelter syndrome (which means having more than one X chromosome), having a strong family history of breast cancer or genetic mutations, and having been treated with radiation to the chest. 

Details about breast cancer, for women and men, can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Breast cancer patients 45% more impaired

Largest study to date of the condition validates women's 'chemo-brain' discomfort 

Women who've had read cancer know about the dread and discomfort of 'chemo-brain' first-hand.

But now, the largest study of it conducted so far proves that the condition — which includes impairments in memory, paying attention and processing information — can be a major problem for up to six months after chemotherapy.

Michelle C. Janelsins, Ph.D.

According to investigators at the University of Rochester's Wilmot Cancer Institute, led by Michelle C. Janelsins, Ph.D., 581 breast cancer patients treated at sites across the United States were compared to 384 healthy patients.

The women with breast cancer exhibited 45 percent more impairment, ScienceDaily reported this week.

Is chemotherapy the only cause of the condition?

No. 

The story indicates some impact may have stemmed from heightened anxiety and depressive symptoms from the onset (diagnosis and pre-chemo), being of a younger age and being a member of the black race.

Regardless, the LiveBetterWithCancer website has suggested a much longer influence for chemotherapy. 

Last fall it published a piece saying a study of mice had indicated that the animals' cognitive impairment could equate to 10 years in humans and "have a long lasting impact on the quality of life of cancer survivors."

The site noted that 'chemo brain' might translate into confusion, difficulty multi-tasking, finishing sentences, finding the right words or learning new skills. 

Personal details of my wife's chemo-brain can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Disease rates plummet to lowest point since 1988

Where does Marin, once home of the worst breast cancer rate in the world, stand now?

I've been waiting a year for yet another shoe to drop.

That, I learned long ago, is what happens with almost every bit of research, but especially those concerning breast cancer. 

Flip-flopping in the cancer industry has become de rigueur.

The most recent shoe drop came at the tail of 2015 when a then-new report indicated breast cancer rates in Marin County — which previously had been believed to be a cluster of the disease — had plummeted to their lowest level since tracking began in '88.

That decreased rate, a county report had noted, matched (instead of topping) the statewide average.

That study, of course,  contradicted earlier reports dating back to the first fallen clodhopper in 1994. The Marin rate then was called the highest in the world, according to a study by the Northern California Cancer Center (since renamed the Cancer Prevention Institute of California).

Marin's rate actually peaked in 2001, when the numbers for non-Hispanic white women had climbed 60 percent. 

Since that year, it's dropped 31 percent.

Why? 

Well, risk factors for Marin's white women have been listed as outgrowths of their being affluent — including higher alcohol consumption and the delayed age of childbearing, not necessarily in that order. 

And, until 2002, a heightened use of hormone therapy (especially an estrogen/progestin combination).

When those hormones were abandoned as treatment, the cancer rates began to descend. 

Quickly.

Despite the obvious connection, few would risk verbally pinpointing why the severe dips had occurred — or why the rates had actually been so high in the first place.

Dr. Mary Mockus, a principal researcher with the Marin Women's Study, long-term, county-led breast cancer research involving nearly14,000 women, did say she thought earlier detection and increased patient awareness had helped.

At the same time, authors of the study discounted any influence changes in mammography screenings might have had. 

Rose Barlow

The decade-old Women's Study, according to its website, is currently researching established risk factors, effects of pregnancy, adolescent risk factors, environmental agents and risk prediction.

That research organization, not incidentally, won a reprieve last year after my adopted home county chose not to finance additional work.

Dr. Mark Powell of Greenbrae rescued it by leaning on crowdfunding and the Avon Foundation — and partnering with several groups, including Zero Breast Cancer, a Marin nonprofit headed by Rose Barlow that I wholeheartedly endorse. 

Still, there's been no updates from the researchers recently, so I wait.

And wait. And wait.

I have a vested interest in knowing if there's a root cause in Marin — monolithic or not — because here's where my wife was diagnosed with the disease more than two decades ago.

Meanwhile, frequent flip-flopping results stemming from cancer research are well documented in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at caregivers.

Blacks, Hispanics, Asians lose 'huge advantages'

Minorities underrepresented in drugmaker-sponsored clinical trials on immunotherapy

Cancer patients who are people of color apparently are disproportionately being left out of experimental trials on immunotherapy.

According to a piece by Denise Grady last week in The New York Times, researchers are aware folks getting the treatments "have been overwhelmingly white."

But scientists claim they're trying to remedy the situation.

Some cancer centers are attempting to bring the trials to black, Hispanic and Asian patients instead of making those potential clinical trial participants come to them.

Immunotherapy, which the article calls "the hottest area in cancer research and treatment," involves drugs that help immune systems fight cancer.

The Times piece focuses on two major 2015 studies of "nivolumab, a type of checkpoint inhibitor, one of the most promising drug classes for cancer," and says that "patients taking it [in both tests] lived significantly longer than those given chemotherapy."

In the first case, 92 percent of the patients were white; 88 percent were in the second. Census figures for 2015 show Caucasians make up only 77 percent of the U.S. population.

According to the Times piece, researchers say studies of nivolumab may omit minority patients "because it can take longer to find and enroll them," an obstacle disliked by drug makers such as Bristol-Myers Squibb, which financed the lung and kidney studies of that particular med.

Testers, the Times article notes, claim that one major cause of the problem is that "people in minority groups tend to have lower incomes and less education, and therefore less awareness of medical studies and how to find them."

Another reason may be that many live in areas that don't have easy access to a prime cancer center.

Dr. Julie R. Brahmer

Moreover, the piece goes on to quote Dr. Julie R. Brahmer of the Johns Hopkins Kimmel Cancer Center as saying, "minority patients with cancer are more likely to have other, poorly controlled chronic diseases like diabetes, that make them ineligible for studies."

In addition, some financial hurdles may be impossible to surmount — "frequent trips to the hospital, requiring time off work and expenses for travel, parking and child care. Some doctors simply assume that lower-income, minority patients could not afford it."

The irony, the Times indicates, is that clinical trials, which usually provide expensive drugs and treatments without charge, "can be a lifeline" that offer "huge advantages" such as "new treatments that may otherwise be unavailable."

Information about cancer research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

BRCA1 tests increase but results are questioned

Did Angelina Jolie op-ed in N.Y. Times help women find breast cancer gene mutations?

Angelina Jolie

Although celebrities can spur women to gather information about breast cancer, the question remains how valuable resultant data will turn out to be.

Angelina Jolie is a case in point.

According to a story by Carolyn Y. Johnson this week in The Washington Post, a new study published in the British Medical Journal has indicated that additional thousands of women in the United States were tested for breast cancer gene mutations right after the actress went public about her decision to get a double mastectomy.

Her choice was based on the fact that she had BRCA1, one of the mutations that increases chances of developing breast and ovarian cancers.

The Post piece noted that "testing rates increased 64 percent in the three weeks after Jolie's [op-ed in The New York Times went viral in 2013].

But that stat, based on research at Harvard Medical School, also showed it cost about $13.5 million to do the additional 4,500 genetic tests.

Unfortunately, researchers concluded, "mastectomy rates among women who had a genetic test actually declined after the [New York Times] piece was published, suggesting the women who got the tests done weren't as likely to have the mutation."

More information about the BRCA1 and BRCA2 genes can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.