Celebrating one year of blogging...

A year ago we officially launched our blog. Although we had been blogging for a few months prior to telling anyone it's only been a year that our patients have actually known about the blog. In fact, in just one year over 4,000 people have visited our blog! We're honored that so many people have found our information both helpful and encouraging.

In the spirit of New Years Resolutions we'd like to direct you back to some of our favorite "life changes" articles. And as always, leave us a note in the comments if you want us to cover something new.

• Quit Smoking: As a patient undergoing cancer treatment the effects of both first hand and second-hand smoke are clearly document, and it's not good. Check out this article from our very own Dr. Harris for more information >>
• Exercise more to help your cancer treatment: Last year Laura, an occupational therapis at Providence who specializes in lymphedema, oncology rehabilitation and manual therapy talked about exercising during cancer treatment. Read more about the positive effects here >>
• Change your diet, recover energy: When Dr. Sui wrote about taking charge of your cancer-related fatigue he sparked a great dialogue about changing your diet. Read the reader response to his article here >> 
• Learn how to cope with the fear your cancer will come back: Dr. Whitten's two part article covered not just understanding the fear your cancer will come back but also provided five strategies for coping. Read more here >>

7 'take charge' tips from our new breast cancer navigator, Andrea Potter, RN

Welcome breast cancer navigator Andrea Potter, RN!Many of you may already know or recognize me because I have been caring for cancer patients in the community for the past eight years. The Providence Regional Cancer System is like family to me. I began my nursing career here and know the doctors, the staff and the community.

In recognition of Breast Cancer Awareness month, I want you to feel empowered as your own health advocate. Remember that you are not just a patient, but that you are the customer and should be made comfortable and happy. Here are some ‘take charge’ tips:

• Simplify things by keeping a journal and calendar to track symptoms and appointments.
• Be honest with your doctor about how you’ve been adhering to your treatment plan.
• It’s ok to seek a second opinion.
• Keep your own medical file and request copies of your records.
• Let me help you with practical problems that can get in the way like temporary housing, transportation or financial support.
• Take care of your emotional health by using counseling or integrative therapies.
• Keep up on changes in breast cancer research.

I am here for you throughout this journey, and the sky’s the limit to the resources I can help you access and support I can provide.

Customized treatments can enhance breast cancer care

Not all breast cancers are the same, and tailoring treatments for different types is becoming increasingly common in cancer care. This approach has improved cure rates in some patients and allowed others to avoid unnecessary treatments.

At Providence Regional Cancer Center, we customize therapies in a variety of ways. Gene analysis is one technique, which may be used when it’s not clear if a patient’s particular form of breast cancer will benefit from chemotherapy.

The gene analysis test we use looks at 21 genes and gives us an idea of whether the patient has a low, intermediate or high likelihood of recurrence. Patients with a high recurrence score will typically benefit from chemotherapy, while people with an intermediate or low recurrence score will not gain additional benefit over the hormonal therapy they have already been prescribed.

For other breast cancer patients, including the 20 to 25 percent who have what’s known as HER2-positive cancer, “targeted” therapies have shown success. This type of breast cancer occurs when the HER2/neu gene mutates, which can result in cancer that is often less responsive to chemotherapy.

However, we now know that combining chemotherapy with Herceptin®, a drug that specifically targets a protein created by the HER2/neu gene, can improve treatment response and increase cure rates.

As cancer physicians, we are continuously looking for new ways to treat cancer, with the ultimate goal of curing it, or at least managing it as a chronic medical condition. In our practice at Providence Regional Cancer System, we have a special committee that reviews new treatments (for breast cancer as well as other cancers) which have recently been approved by the FDA.

This committee, called the Medication Management Team, includes doctors, nurses, pharmacists and other staff. The team evaluates new treatments and makes recommendations on how to implement them in the clinic as quickly and effectively as possible in order to help our patients.

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Coping with cancer paranoia

As a cancer survivor, I worry about getting cancer again. But I worry even more about my kids getting it. When my first child, Will, was ten months old I noticed tiny red spots on his arms. In a panic, I rushed him to the pediatrician. (Red spots on my legs – which meant my blood wasn’t clotting properly – were one of the first signs of my childhood leukemia).

The doctor reassured me that Will’s spots were harmless. He also reminded me that cancer in children is really quite rare. Rationally I knew he was right, but I also knew better than most that – yes – it may be rare, but it does happen.

My next scare happened a few years later with Will’s younger brother. My husband and I noticed a lump on Jonathan’s lower left leg. I googled “kids, lumps and cancer” on the internet. Sarcoma came up – a cancer of the soft tissue. What I read about sarcomas in children was not good. My stomach started doing somersaults, and the rest of me felt like crumpling on the floor and pretending this wasn’t happening.

We took Jonathan to the pediatrician, who wasn’t as reassuring as he was with Will. Instead he referred us to a surgeon at Children’s Hospital. When we saw him, the surgeon couldn’t immediately diagnose the problem, so he recommended we bring Jonathan back for testing.

After a long week of waiting, an ultrasound showed no sign of cancer. The lump was, weirdly, caused by an “unidentified foreign object” – possibly a splinter of wood – that had lodged in Jonathan’s leg. Since there was no infection or pain, he would not have to undergo surgery or treatment…big sigh of relief.

With the latest kid crisis behind me, I was free to leave the hospital. But I wasn’t free of my cancer paranoia. My kids, unfortunately, aren’t the only recipients. My husband has been victim to it, and if my parents, brother and nieces lived closer, I’m sure they would be, too.

Not surprisingly, I also turn these fears inward and worry about getting cancer again myself. Any odd lump, spot or pain in my body can send me into high-anxiety mode. I went online and typed in “cancer paranoia” to find out if others experience this, too. Many results came up. Some were from people who’d never had cancer and were terrified of getting it; others were from survivors who’d had it and were terrified of it returning.

I couldn’t find anything about transferring cancer paranoia onto family members, but I’m guessing I’m not alone. Fortunately, in my own family, my husband (who’s known me for 23 years) has long since learned to deal with my random moments of paranoia. And my kids are still too young to notice when those moments occur. As for me, I’ve come to realize the paranoia is something I’ll likely deal with, to some extent, for the rest of my life. I try to keep it in check and not let it impact me or family members too much. It’s just a residual effect of having cancer and probably not something I’ll ever be able to shake completely.

All cancer is genetic, but few cancers are inherited

Editors Note: We realize the content of this article is incredibly scientific. However, we strive to bring you the most factual information we can and in this case all the information provided helps to paint a complete picture of Dr. Whitten's article.

If you have questions please don't hesitate to comment.

All cancers have genetic abnormalities. This means the cancer cell’s DNA or genes (which reside in the chromosomes) show alterations. In some cancers it seems to take only a single change to cause the cancerous growth.

For example, one type of leukemia (chronic myelogenous leukemia, or CML), shows a characteristic break between two separate chromosomes with abnormal joining of part of one (chromosome 22) to part of the other (chromosome 9) creating a new abnormal fused chromosome (the famous Philadelphia chromosome).

This break and reconnection brings together, or fuses, two normally separate genes that now behave abnormally, creating uncontrolled cancerous cell growth.

What does this mean, exactly?
All cancers have genetic abnormalities in the cancer cells themselves, but the person who has the cancer does not show these abnormalities in any other cells of their body including their germ cells (eggs and sperm), so they are not passed on to future generations or inherited.

What about the “breast cancer gene”?
There are uncommon hereditary cancers, however. Abnormal genes that were present in the parent’s eggs or sperm can mean an individual inherits an increased risk to develop cancer.

An example is the famous BRCA-1 mutation that increases the risk of breast, ovarian and other cancers in those who inherit a mutated BRCA-1 gene. All cells have 2 copies of every gene and if one inherits mutations in both copies of an important gene like BRCA-1, then the embryo usually does not survive and is spontaneously aborted early in pregnancy, often before the mother knows she is pregnant.

If one inherits a mutation in only one of the copies of the gene then the embryo lives, but has an increased risk of problems such as developing breast cancer in the case of BRCA-1. Most breast cancers do not occur in patients with this hereditary risk, but if you do inherit a mutation in BRCA-1, then your risk is many times higher that you will develop breast or ovarian cancer in your lifetime. That is, most breast cancers arise in patients without a hereditary BRCA-1 mutation or other family history of early or frequent breast cancer.

Another example is an inherited mutation in one of the copies of a DNA repair gene (one that fixes mistakes that invariably occur during copying of DNA to make a new cell) that is inherited and leads to an increased lifetime risk for colon cancer called the Lynch syndrome. Like the BRCA-1 situation, this inherited risk accounts for only a small fraction of all colon cancers (15%), but if you have this mutation, your lifetime risk is much higher than someone who did not inherit the mutation.

What do I do?
If several close family members have developed these cancers at unusually young ages (that is you have a family history of these cancers), then you may carry one of these mutations. Laboratory tests are available to look for the BRCA-1 and Lynch syndrome mutations and several others that are known to lead to an increased hereditary risk for cancers. Talk to your doctor about the appropriateness of genetic testing and counseling for your individual situation.

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