River of Hope
There's reason to be hopeful about breast cancer: Rates are going down and more women are surviving the disease. Follow our guide to reduce your risk, get the best treatment, and help others cope.
Rachele Kanigel
10/2007
10/2007
It's hard to imagine a body part that stirs more pleasure and more angst for women than breasts. As 10-year-olds, we wonder if they'll ever emerge. As young women, we learn about their magnetic power to turn men's heads. As nursing mothers, we revel in their ability to give sustenance. And as sexual beings, we thrill when they're stroked and caressed.
Robert Smith, Ph.D., director of cancer screening for the American Cancer Society, says there are several reasons why fewer women are getting regular mammograms- and most of them aren't good. The number of mammography facilities, technicians, and radiologists have all declined since the late 1990s, leading to longer waiting times and reduced accessibility. The drop in hormone replacement therapy may also play a role: If women aren't seeing their doctors to monitor their hormones, Smith says, they aren't getting that reminder to have a routine mammogram. Some women may have lost their health insurance or had their rates go up, which may lead them to put off mammography, Smith says.
Treatment: Cancer Fighter
Mary Tagliaferri was 29 when she found a hard lump the size of a grain of rice in her left breast. The cancerous tumor was small and hadn't spread, but her case confounded her doctors, who were unsure of how to treat such a young patient. Lumpectomy or full mastectomy? Should she have chemotherapy, which could send her into early menopause?
How to Cope: Yoga
Yoga is a natural choice for breast cancer patients trying to relieve the stress of diagnosis and treatment. Now researchers are finding that women who engage in a regular yoga program may reap even more benefits.
How to Cope: Food
As a food writer and gourmet chef, Jennifer Omholt always made food an important part of her life. She routinely threw dinner parties for 14 and loved to sample exotic menus. But when she was diagnosed with breast cancer at age 44, just 18 months after the birth of her son, she no longer craved fancy dining spots and rich recipes.
Reach Out: Share the Care
Well-meaning offers of assistance to a woman facing breast cancer often get lost in the chaos of a medical crisis. Too often we don't know how to help, and the patient and her family are usually too overwhelmed to ask.
For all the joy they bring, they also trigger their share of anxiety. We fret that they're too small or too big. We worry about blue veins and sagging flesh. And worst of all, we fear that an errant cell somewhere may be growing and dividing, forming a tumor that could change our lives forever.
The fear is real: About one in eight American women will develop breast cancer during her lifetime. This year an estimated 240,510 women will be diagnosed with breast cancer and about 40,460 women will die of the disease, according to the National Cancer Institute.
But even in the harsh statistics, there's some good news: Breast cancer rates are on the decline and are now at their lowest level since 1987. In 2003, researchers noted a sharp drop in breast cancer incidence, followed by another dip the following year, the last year for which national statistics have been analyzed. Overall, in 2003 and 2004, 30,000 fewer women developed breast cancer than health officials had predicted based on previous trends, according to a study published this year in the New England Journal of Medicine by biostatisticians at the University of Texas M.D. Anderson Cancer Center.
The drop coincides with two other trends-a reduction in the use of hormone replacement therapy and declining use of screening mammography-so the question remains whether there are fewer cases or if fewer women with breast cancer are being diagnosed.
In 2002, millions of women dumped their hormone supplements (and many others decided not to start taking them) after the Women's Health Initiative reported that women who were on hormone replacement therapy for an extended period of time were at increased risk of breast cancer, stroke, and heart attack. After analyzing the data in detail, the M.D. Anderson researchers came to the conclusion that the dramatic shift in hormone usage could explain the drop in breast cancer cases.
However, some health officials believe the decrease may also be related to a decline in the use of mammography. The proportion of women 40 and older who said they had a mammogram in the past two years dropped from 70 percent in 2000 to 66 percent in 2005, according to the National Cancer Institute. "There may be cancers, but they'll be found later, when the disease is less treatable," says Christy Russell, M.D., codirector of the University of Southern California/Norris Lee Breast Center.
"If women want to be proactive to reduce their chances of dying from breast cancer, they cannot give up on mammograms," Russell says. "It's the one weapon they have."
Mammography remains the most effective way to catch breast cancer. But how can a health-conscious woman keep from getting the disease? The most important risk factors-genetics, age, race, reproductive history-can't be changed. But there are several things you can do to reduce your risk:
- Don't smoke Numerous studies show that tobacco increases the chance of breast cancer. A 2002 study by researchers at the Albert Einstein School of Medicine found that the more cigarettes women smoked and the longer they kept up the habit, the higher their risk of developing the disease was.
- Cut back on alcohol Just two drinks of alcohol a day have been shown to significantly increase breast cancer risk, according to multiple studies.
- Maintain a healthy weight Women who are overweight or obese after menopause are at increased risk of developing breast cancer. A 2002 study by the American Cancer Society estimated that 30 percent to 50 percent of breast cancer deaths among postmenopausal women in the United States may be attributed to obesity.
- Exercise regularly In a 2003 study from the national Women's Health Initiative, women who walked briskly for a couple of hours every week had an 18 percent lower risk of breast cancer than sedentary women. Those who got more than ten hours of vigorous exercise each week lowered their risk by about 22 percent.
- Reduce estrogen exposure Avoid prolonged hormone replacement therapy. If you're bothered by menopausal symptoms, consider taking black cohosh, an herbal remedy. In a 2007 epidemiological study, researchers at the University of Pennsylvania found that women who had taken black cohosh supplements had a 61 percent lower risk of developing breast cancer than other women.
- Eat well Aim for a mostly plant-based diet rich in fruits, vegetables, and whole grains. Be sure to eat some of the cancer-fighting foods listed on the next page.
Mary Tagliaferri was 29 when she found a hard lump the size of a grain of rice in her left breast. The cancerous tumor was small and hadn't spread, but her case confounded her doctors, who were unsure of how to treat such a young patient. Lumpectomy or full mastectomy? Should she have chemotherapy, which could send her into early menopause?
Knowing she wanted to have kids, Tagliaferri chose a simple lumpectomy and radiation rather than chemotherapy and a mastectomy. Then a newly licensed acupuncturist, she sought the advice of a Chinese herbalist, who gave her a list of 20 Chinese herbs and instructed her to brew them together and drink the concoction three times a day. For a year, Tagliaferri downed the drink religiously and also got acupuncture treatments, all the while hoping the wisdom of a medical system that traces its lineage back thousands of years would make her well.
Eleven years later, Tagliaferri, 41, is a single mother of two children, the editor of a well-respected book on alternative treatments for breast cancer, an M.D., and president and cofounder of Bionovo, a pharmaceutical company that uses botanical products to develop drugs for women's health and cancer. "Our research is based on the principle that the planet contains the resources we need to heal ourselves," she says.
Bionovo's most promising breast cancer treatment so far is BZL101, a compound derived from the flowers and stems of Scutellaria barbata, or skullcap, one of the herbs Tagliaferri took when she was battling breast cancer. Laboratory experiments suggest the compound selectively kills cancer cells while sparing healthy cells. A preliminary study of 21 patients with metastatic disease found the drug was well-tolerated and safe. This year Bionovo launched a larger study that will eventually include 80 patients with late-stage breast cancer. The research will be conducted at ten major medical centers, including the University of Texas M.D. Anderson Cancer Center, the University of California, San Francisco, Columbia University, and Duke University.
Scutellaria barbata is one of the 75 herbs Tagliaferri and her colleagues have screened in the two years since they founded Bionovo (of those, 25 have shown promise). But she cautions against taking these herbs and applying them to Western diseases. "They don't have cancer in Traditional Chinese Medicine," she explains. "They talk about the eight principles-yin and yang, hot and cold, excess and deficiency, interior and exterior. We have to translate the poetry in order to use this medicine."
Yoga is a natural choice for breast cancer patients trying to relieve the stress of diagnosis and treatment. Now researchers are finding that women who engage in a regular yoga program may reap even more benefits.
In a 2006 study, scientists from the University of Texas M.D. Anderson Cancer Center compared two groups of women undergoing radiation treatment. One group took two hour-long yoga classes that included physical stretching, meditation, and breathing exercises each week; the other group was put on a waiting list for the class. The scientists found that women who engaged in yoga enjoyed better health and experienced less fatigue than the control group.
Based on the results of the pilot study, researchers have received grants from the National Cancer Institute to conduct larger clinical trials of yoga for breast cancer. "There's good reason to believe that yoga as well as other mind-body practices can be useful for people facing lifechanging illnesses," says Lorenzo Cohen, M.D., director of the integrative medicine program at the cancer center.
In another study, researchers at Washington State University, Spokane, found that Iyengar yoga-an active type of practice that stresses proper body alignment- not only promotes psychological wellbeing in breast cancer patients, but may cause potentially beneficial changes in immune-system cell activity.
Recognizing the benefits of yoga, a number of cancer centers now offer yoga classes designed specifically for cancer patients. These may offer more gentle exercises or focus on particular skills, like arm movement and flexibility, that could become impaired as a result of cancer treatment. Even if you can't find a yoga class tailored to people with cancer, a restorative, gentle yoga class can offer many of the same emotional, spiritual, and physical benefits.
As a food writer and gourmet chef, Jennifer Omholt always made food an important part of her life. She routinely threw dinner parties for 14 and loved to sample exotic menus. But when she was diagnosed with breast cancer at age 44, just 18 months after the birth of her son, she no longer craved fancy dining spots and rich recipes.
Suddenly food wasn't just about good taste-it was a vital component of staying alive. "I was desperate to find a new way to cook," says Omholt, who lives in Marin County, just north of San Francisco. "I knew how to cook gourmet; now I needed to learn to cook to heal myself."
Her acupuncturist referred her to an eight-week cooking class, Culinary Solutions for Prevention and Healing, taught by Rebecca Katz, a chef at the Commonweal Cancer Help Program in Bolinas, Calif. But it was held on Thursdays-the day she usually had her chemotherapy treatments. Undaunted, Omholt and a friend drove 40 minutes away to the classes in Point Reyes Station, a tiny town on the coast.
As they traveled through the cattle-dotted rolling hills of West Marin County to the home where the classes were held, Omholt would feel her body begin to relax. "There were always fresh flowers on the table, and things were always bubbling on the stove," Omholt says. "It removed me from what I called 'cancer world.' I could just enjoy myself and forget about everything."
During the classes, she learned that omega-3 fatty acids decreased inflammation and that kombu, a Japanese seaweed, is packed with health-enhancing minerals. She learned to cook leafy greens like kale and chard-and Katz's signature Magic Mineral Broth, a tasty vegetable stock high in potassium and other trace minerals that are often depleted by cancer treatments.
"For cancer patients, the food has to be packed with nutrients and have what I call the 'yum factor,'" says Katz, author of One Bite at a Time: Nourishing Recipes for Cancer Survivors and Their Friends (Celestial Arts, 2004). Omholt radically changed her diet, cutting back on unhealthy fats, reducing her intake of meat and dairy products (which she feared might contain hormones), and eating organic produce. Friends and family members offered to bring her food, but they were intimidated when she listed her dietary restrictions. So Katz agreed to teach a series of quarterly cooking classes to Omholt's caregivers. Every three months for two years, Katz would come to Omholt's kitchen to show her loved ones how to make health-enhancing muffins, soups, and stews.
Omholt says the new way of eating helped get her through six months of chemotherapy, three months of radiation, and five surgeries. "Food played a major role in helping me heal emotionally and physically," she says.
Five years after her diagnosis, Omholt is back to throwing elaborate dinner parties. But these days her menus include dishes like kabocha and butternut squash soup, poached salmon, and desserts sweetened with maple syrup instead of sugar.
Well-meaning offers of assistance to a woman facing breast cancer often get lost in the chaos of a medical crisis. Too often we don't know how to help, and the patient and her family are usually too overwhelmed to ask.
ShareTheCaregiving, a nonprofit organization with a book (Share The Care, Fireside, 1995, 2004) and a website (sharethecare.org), offers a practical approach to forming a support network for a person who is ill. The 1995 book grew out of a life-changing experience authors Cappy Capossela and Sheila Warnock had when they helped care for a mutual friend, Susan Farrow, who was suffering from cancer that had metastasized to her bones.
For more than three years, 12 women- most of them professionals with busy lives- cooked and shopped for Farrow, ferried her to medical appointments, and kept track of her medications. They even organized her daughter's wedding six months before Farrow died.
In January 2002, seven years after Share The Care was published, Capossela was diagnosed with a malignant brain tumor. Warnock quickly put together another Share The Care group to support her. "When you're working as a group, you have more resources. One person can research the Internet, another can talk to doctors, a third can go to a medical library."
In its handbook and website, Share The Care lays out the steps for creating a care network, from assessing the patient's needs to setting up a schedule and ensuring the caregivers get the support they need.
Mindy Gribble, the nonprofit coordinator for Circle of Life Community Coalition in Marshfield, Wis., used the Share The Care model when her friend Sharon Groff was dying from metastatic breast cancer. A large group of friends and neighbors contributed to Groff's care. "All the jobs got done, and nobody felt stressed out," says Gribble. "Everybody felt they got back more than they gave."
For Warnock, caring for another human being is inspiring. "It can be hard, difficult, heavy work. But it also gives you a sense of the great light, grace, and beauty of the human spirit."
Also be sure to check out our sister publication's website, shape.com for more information on breast cancer.
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