Articles

If appointed to the Supreme Court, Amy Coney Barrett’s vote would be instrumental in deciding the fate of the Affordable Care Act. If it’s repealed during November’s landmark case, many could lose access to cancer screening and treatment.

Patients with Cancer Stand to Lose if Supreme Court Repeals ‘Obamacare’

Videos

On behalf of METAvivor, CURE spoke with Jamil Rivers and Kate Watson about metastatic breast cancer – from its treatment to how it affects individuals and their families.

Learning the Ins and Outs of Metastatic Breast Cancer

Numerous challenges present themselves when a patient chooses to get screened for colorectal cancer, but we know very little about why patients may opt-out of getting screened.

Patient Inhibitions A Significant Barrier to Colon Cancer Screening

Organized as a virtual event, the DONNA Foundation’s 2021 National Marathon to Finish Breast Cancer will allow participants to run in their neighborhoods — or on their treadmills. 

Participants of the DONNA Foundations 2021 National Marathon to Finish Breast Cancer Will Lace Up Their Running Shoes Virtually

Patients with myeloma should talk to their clinicians about getting the most out of the first treatment they receive for the disease, as it can affect their long-term outcomes, says Patricia Mangan, a hematology nurse practitioner at the University of Pennsylvania Abramson Cancer Center.

“One thing to stress is that typically, your first remission is the longest,” Mangan said during a presentation at the NCCN 2020 Virtual Congress on Hematologic Malignancies Nursing Forum. “Once you choose to treat someone with myeloma, you want to do it as aggressively as they can tolerate to get the biggest bang for your buck.”

Mangan explained that not all myeloma needs to be treated right away. However, if patients experience any of the following, it might be time for them to start a drug regimen:

Anemia (low levels of healthy red blood cells)

More than 60% of plasma cells in bone marrow

The first line of treatment for patients with myeloma is typically a three-drug regimen including a proteasome inhibitor, immunomodulating agent, and steroids or dexamethasone. If a patient is eligible, they may then undergo an autologous stem cell transplant.

\“Once someone is diagnosed and they need to start treatment, there’s a quick decision of: Is this person potentially eligible for stem cell transplant or not? Do they have comorbid issues? Are they not fit or too old to undergo transplant?” Mangan said.

These questions need to be answered at the start of treatment, and a decision of transplant or no transplant should be made as soon as possible.

Patients who are able to get transplants will do so, and then likely be given maintenance therapy to keep the disease at bay. Conversely, those who are not transplant candidates can be given aggressive therapy upfront, and then, “start to peel off some of that initial treatment to get them on a maintenance of that to maintain remission,” Mangan said.

Remission after the first treatment tends to be the longest and most durable. However, most patients with myeloma will eventually relapse.

Luckily, there are now more options than ever before for the second- and third-line treatment of the disease.

“We can keep people doing well for a long period of time … our myeloma patients are survivors,” Mangan said. “They’re living much longer with each new year of treatments that come out.”

A version of this article was originally published on OncNursingNews.com as, “

Frontline Treatment Decisions Are Crucial in Myeloma

Not everyone with myeloma needs to be treated right away, but when they do, there are some important upfront considerations for patients and providers. 

Myeloma: The First Remission Is the Deepest

Kim is a nursing student who is hoping to find her place amongst the phenomenal oncology nurses and doctors who cared for her sister. She loves reading, volunteering and enjoying the outdoors of Colorado.

When my sister was diagnosed, I made choices that differed from my siblings. I assumed the role of caregiver, but even before I made that choice, I chose to set aside our pasts due to cancer. She was twenty-seven at diagnoses, and I was twenty-three, and we had a lot of history between us. Although we shared a room for most of our youth, growing up, we were not very close. I was far closer to my twin brother and my childhood friends than I was to her.

We had very little in common and were opposites in nearly every way. Through our teens, we struggled to get along, and my sister behaved in numerous ways that were self-serving and hurtful to both myself and my siblings. She was, at times, violent and could be self-centered. In part, these are some of the reasons my siblings chose not to be there when she was diagnosed.

I fell somewhere in the middle. I could understand how those outside the family could not fathom their choices. And yet, a part of me could understand their choices. I could not make the same choices they were making. Regardless of our childhood, she was facing 

, and I knew that if I were to find myself where she was, I would hope that people would be there for me. And so, I chose to be there for her.

As my sister’s caregiver, I gave up a lot. Some of it willingly, some of it because I did not know what else to do. And some of it because I did not have a choice because my sister appointed me as her power of attorney without asking permission. When I took on the role, I did not really know what being a caregiver meant. It took me until almost the end of cancer to even begin to understand that what it did not mean was giving up myself for another. Caregiver or not, I was still my own person, which allowed me to set boundaries and say no.

Early on, I would hear people say that cancer changes people. That statement sparked a hope inside me that my sister might have become a different person. That despite all that had happened and who she had been, that cancer would change her for the better. I hoped that my sister would become more appreciative of those around her, for her to become kinder and less manipulative than she had been before her diagnosis. To some, that may seem odd, but I had really hoped that it would be true. And in the end, cancer did change somebody it just was not my sister. It was me.

I am a vastly different person than I was before her diagnosis. The awakening that I had hoped would occur did not, as my sister has mostly remained the person that she was prior to cancer. While we spent copious amounts of time together during cancer, and even in the months that followed her remission, our relationship has returned to what it used to be.

To have given nearly four years of my life to try and save hers is something I may do differently if I could. Yet, it is still something that I would choose to do time and time again if faced with the same circumstances again. People often ask me how my sister is doing, and the truth is—I am not sure. As of now, we barely speak anymore. Do I wish it could be different? Sure. She is still my sister, and always will be. That said, it takes two to have a healthy relationship.

When she was diagnosed, I chose to set everything aside.

Through cancer, I continued to do so and used cancer as an excuse for her behavior towards both me and others. I continued to blame everything but my sister, and even once cancer came to an end, I did not see that she was partially accountable for our relationship. Until one day, I chose to do it differently. I decided to not be the one to pick up the phone or to be the only one planning to get together. Cancer does change so much in life, for both better and worse, and as much as I wish cancer could've changed our relationship, and while I hold on to hope that one day it may, I have come to terms that it may not.

Any other caregivers out there struggling with a relationship with the one they are caring for, or once cared for; you are not alone.

We choose their well-being over ourselves for many reasons. But I encourage you to do what has taken me far too long to do and choose yourself. If you can maintain a healthy relationship- excellent. And if you cannot, it is okay to set boundaries and even to walk away. Being a caregiver means that you can, and you should take care of yourself too.

Caregiving is a journey unto itself, and one that brings in its own nuances and challenges when caring for a family member with cancer regardless of your relationship to them. 

Navigating Relationships and Boundaries as a Cancer Caregiver

Every day at Memorial Sloan Kettering Cancer Center, I have the privilege of being surrounded by extraordinary people. When I reflect on exactly what it means to be an extraordinary healer, one person in particular comes to mind. Ellen Mulkerrins, B.S.N., RN, OCN, is a dynamic, compassionate and empathetic nurse who leaves a grin on the face of each of her patients.

Ellen has many exceptional qualities. Her focus is on the highest standard of patient care. I have seen this consistently while working side by side with her in many challenging and difficult patient and family situations. But I personally saw Ellen’s true gift when she cared for my own family member. Nothing was too much for her to make sure my family member was comfortable, monitored closely and, especially, could laugh, making his hospital stay easier. Her compassion, kindness and dedication will never be forgotten.

One of the things that set Ellen apart from other nurses is her ability to sense unspoken needs. As the unit representative for the supportive care committee, Ellen places the utmost importance on the care of the suffering and dying patient. No one will ever forget how she made one of her patients’ last requests possible. This patient came into the hospital, took 

a turn for the worse and spent the remainder of his life there. He formed a special bond with Ellen. 

Between Ellen as his nurse and the Hulk doll that never left his side, he said he felt as secure as could be. He confided in Ellen, telling her that the one thing he regretted was not marrying his lifelong partner. One afternoon, Ellen coordinated a wedding ceremony in the room. Complete with music, flowers and two nurses walking the woman down the “aisle,” the event left us all with tears running down our faces and a sense of warmth. Before Ellen completed his care, the patient entrusted his precious Hulk doll to her, telling her that he now had all that he needed.

Ellen not only provides exemplary care for patients but also truly embodies the “care of colleague” tenet of our Memorial Sloan Kettering professional practice model on relationship- based care. Ellen and I were co-chairs for our inpatient nursing recruitment, retention and recognition council, through which she worked tirelessly to make sure that nurses received recognition for excellence in care. 

During her time as co-chair, she helped support and expand the department’s recognition programs, including the Daisy Award for Extraordinary Nurses and our Shining Star Award for exceptional ancillary staff. Additionally, she leveraged the council structure to make each inpatient unit the best environment in which nurses can prac- tice. Ellen’s dedication and compassion for both patients and colleagues are beyond reproach, and she truly exemplifies the attributes of an extraordinary healer.

The words below, from some of Ellen’s other colleagues, describe the impact she leaves on all she meets.

: To Ellen, caring for patients is not just a job but a passion. She treats each patient as if they were her own family. There is no request from a patient that is too big for Ellen. If there is anything she has taught our staff over the years, it’s that the small things count. All her patients are left smiling, asking for pillows to brace their fresh surgical incisions as they try not to laugh. No matter how difficult the day, Ellen’s passion and joy for the patients and their families is evident. We always tell Ellen that her sense of humor is unprecedented. It is a trait that has lifted the spirits of even the most downcast patients. 

She embodies the qualities of a nurse who goes above and beyond in everything she does, whether it be leadership, patient care or care of a colleague. Everyone Ellen encounters is left with a sense of comfort and a lifted spirit. Ellen has a way of getting to the heart of the matter and finding out what is most important to the patient. She not only completes the necessary tasks to make the patient well but also tends to the unspoken needs. 

Ellen takes care of her patients in a holistic manner, treating their emotional needs with the same level of intentionality as their physical ones. The bonds she forms with her patients last beyond their stays.

Oncology nurses tend to the needs of patients with cancer with great care, but they also tend to the unspoken needs of their patients.

Oncology Nurses Tend To The Unspoken Needs Of Patients with Cancer

Martha lives in Illinois and was diagnosed with metastatic breast cancer in January 2015. She has a husband and three children, ranging in age from 12 to 18, a dog and a lizard.

Confession: I’ve never been a great sleeper.

When I was a pre-teen and teenager, my sisters and I would get up early to ride our bikes to 6:30 a.m. swim practices several mornings a week during the summer. In high school, that continued with the addition of springtime early am practices, and in college, it was the same thing but with 2:00 am bedtimes thrown into the mix.

Getting up as early as 5:00 a.m. was my norm. When I started working, I often rode my bike from Brooklyn to midtown Manhattan, which also meant I was up early and I did the same for much of the year when we moved to Chicago. A few years later, parenting meant waking at the slightest noise.

Suddenly, my garden-variety poor sleep habits were thrown into hyperdrive. The 

 has a FAQ about why good sleep is important for people with cancer, including its impact on mental wellbeing and physical health effects like immune function, repair of cells and tissue and regulating blood sugar.

There are countless reasons why people with cancer are more likely than the general population to have sleep issues. Anxiety, pain, drug interactions (in breast cancer, aromatase inhibitors can be a culprit, as can steroids), gastrointestinal problems and more can all play a role.

I’ve found ways of improving my sleep, but there are still times when I know I’m not getting enough sleep, or even any good sleep, and it takes a conscious effort to get back into habits that work, like these:

As with anything health-related, the first step is to let your healthcare team know that you’re having sleep issues. They may have suggestions or can refer you to a specialist.

Instead of adding to sleep stress with the problematic “I’ve got to get to sleep” mental refrain, which only keeps me awake longer, I’ve stolen bits and pieces from cognitive behavior therapy. This included practicing muscle-relaxing exercises and a technique of mental calming I learned as a competitive swimmer. Find small tactics like this to avoid adding to your sleep stress.

This is where I struggle most. There are days when I could crawl gratefully into bed by 7 p.m. even though I know that means I’ll be wide awake at 10 p.m., midnight, 3:30 a.m., until I fall soundly asleep from 5 am until 7 a.m. This is not a healthy behavior. My goal is to stay out of bed until 10 p.m. and stay in bed until around 5:00 or 6:00 a.m.

Ugh. Who among us cannot relate to how beds are now where we read news, scroll through social media, watch movies on tiny screens or play endless games on apps? Guilty as charged. Put the phone away, turn off the television, turn out the lights, cover the clock--help your body understand that the bedroom is where you sleep and not where you go to wake up again.

As with so much in living with cancer, basic healthy behavior can make a difference in sleep too.

I try not to eat a meal or heavy snacks for a few hours before going to bed, I only have caffeine early in the day and try hard to exercise every single day. All of these good habits pay off with better sleep and feeling better in general as well.

For me, so much of life with cancer centers around uncertainty. It’s hard to live that way, so I’ve tried to create routines wherever I can.

I read and have a couple of cups of coffee in the morning at the dining room table, I watch 30 minutes of TV with my husband after dinner, I try to think about my worries and concerns through writing rather than through rumination while lying in bed, and I give myself time to wind down before heading to the bedroom. All of these small routines help as I try to counteract my tendency toward too little sleep.

Cancer can magnify problems with sleep and introduce new ones, but there are easy changes you can make to get better sleep tonight.

Don’t Ignore Sleep Problems That Come From Cancer Treatment

I met Joy V. Hepkins, M.S.N., RN, OCN, an oncology nurse navigator at Mercy Catholic Medical Center — Mercy Fitzgerald Campus in Darby, Pennsylvania, in 2012 when I received a diagnosis of breast cancer. Hearing the words “you have cancer” is overwhelming. In a quest to get some additional information, I decided to join a cancer support group, and Joy was the facilitator of the group at Mercy Fitzgerald. When I met her for the first time, she put me at ease about my upcoming treatment schedule and surgery.

As things progressed with my treatment, I could not attend the meetings. Months went by, but I could always count on a call from either Joy or someone from the group to see how I was doing. Once I was able, I went back to the support group, and, as before, Joy received me with open arms. It was great being back with this joyful group of cancer patients and survivors.

In 2014, I began the process of establishing Sisters R Us Circle of Survivors (SRUCOS) as a non- profit organization to help other women affected by a diagnosis of breast cancer. Joy agreed to be the keynote speaker for our first fundraiser. Then, in 2015, she joined our board of directors to 

help us support underserved patients who have received a diagnosis of breast cancer, providing financial aid, survivorship resources, mammograms and efforts to connect survivors with other breast cancer patient advocacy organizations. As an oncology nurse, Joy has helped SRUCOS meet the needs of patients with cancer and survivors in the most effective of ways.

Joy received bachelor’s and Master of Science degrees in nursing from Gwynedd Mercy University in 2014 and 2019, respectively, and now dedicates her professional time to supporting patients as they receive diagnoses, undergo treatment and live beyond a cancer diagnosis. She continues to impress SRUCOS with her commitment to help patients with all types of cancer. 

Joy is a member of the Oncology Nursing Society (ONS), serving as newsletter editor for the Penns Wood Chapter and a member of the leadership team for the ONS Nurse Navigator Special Interest Group. Additionally, she is a member of the National Coalition of Oncology Nurse Navigators and the Academy of Oncology Nurse & Patient Navigators.

I believe that Joy’s background as a nurse navigator, coupled with her passion to support non- profit organizations in her community, make her an ideal oncology professional who is worthy of the highest recognition.

For more news on cancer updates, research and education, don’t forget to

Oncology nurses are not just supporting for individual patients, but entire patient communities as well. 

How Oncology Nurses Support Patients And Their Community

Barbara Tako is a breast cancer survivor (2010), melanoma survivor (2014) and author of Cancer Survivorship Coping Tools—We'll Get You Through This. She is a cancer coping advocate, speaker and published writer for television, radio and other venues across the country. She lives, survives, and thrives in Minnesota with her husband, children and dog. See more at www.cancersurvivorshipcopingtools.com,or www.clutterclearingchoices.com.

“Wait, you mean you expect me to communicate what 

 need to my family? I mean, seriously? You don’t get it. I mean, I take care of 

, not the other way around.” Does this sound a little like what you may be thinking?

are the one who is fighting cancer. Your loved ones and friends actually want to help you come out on the other side of this, so 

Here is how to communicate what you need, even when it isn’t easy to ask for help:

This is not the time to be strong or to be coy. Your energy needs to be directed toward healing. Unfortunately, your family is not psychic. Please, please, please just calmly ask for what you need. A grocery-store run? A trip to the pharmacy? Someone, to be with you for your next chemotherapy session? A trip through the drive-through? Coupons for local restaurants? Whatever it is you need to be honest about it, don’t feel ashamed to ask.

 or setting up an email “group” for sharing your treatment updates and your needs will save you precious time and energy. Otherwise, it can be draining to hash and rehash everything individually with each person and to make sure everyone is in the loop.

Each person’s cancer experience is unique—their cancer stage and grade specifics, their age, genetics, medical history before diagnosis, financial situation, home-life situation, emotional situation are all unique to you. you will find people who understand what you are saying because they have been there too. You may have a family member who says “Hey, I had exactly what you got.” Nope, don’t necessarily buy it, but don’t spend the energy trying to get them to understand all the details. Connect where 

Online or local cancer-specific support group members may be of more help to you during active treatment. Your family may or may not be there, but you are not alone. Ultimately, your spouse or children or siblings may not understand. Please do not waste your precious energy and time right now trying to get them to understand. Turn to those who already do understand.

That is, for healing, use all the tools at your disposal. What do they call them on that game show? Lifelines? Line them up and use them.

This is more than family, this includes friends and members of your community, maybe a talk therapist (because cancer is so darn 

), support group friends (local and online) and so on.

Unfortunately, as you already know, life is not fair, and cancer is not fair either.

Some of your people will step up and some 

. The sooner you can stop fretting about the ones who aren’t there for you, the sooner you can appreciate and be grateful for the ones who are there. Don’t waste energy trying to explain to those who just don’t get it. Be grateful for the people in your life who do understand you and who are willing to listen and to be there for you.

Cancer is a mini-course in communication. You will learn and grow through this experience and your family and caregivers will grow along with you too.

Communication is key for any relationship, particularly for the changing relationship patients with cancer may have with their family. Here are tips from a cancer survivor on how to navigate this change. 

Communicating With Family On What You Need As A Patient With Cancer

Back when we had a hematology/oncology fellow from Myanmar, we had the curious irony of a young woman from Myanmar winding up in our hospital with a new diagnosis of acute myelogenous leukemia. She knew almost no English and little of the official language of Myanmar but was very fluent in her own local language. 

Substantial communication over the next several months could occur only on Saturdays when someone was available and fluent in both English and the patient’s native language. Far more common, however, is when I try to work with my “little bit of Spanish” and my patient’s “little bit of English” and manage to pretend that proper communication has taken place. All too often, of course, something is lost in translation.

Alicia Castanon, M.S.N., OCN, APRN, FNP-C, is an extraordinary person and an extraordinary healer who has opened the lines of communication between our patients and staff.

Over 45 years ago, I took Texas’ famous River Road from Presidio to Lajitas, and I still clearly remember the ups and downs and the unique wilderness beauty of the area. The Rio Grande is the 20th-longest river in the world, starting at the foot of some of those “fourteeners” in Colorado and going through a series of dams in New Mexico. There is usually no water at all from El Paso to Presidio, but there the mighty Rio Conchos from Mexico brings the water that gives life to the canyons of the Big Bend. On River Road is a small community called Redford, 

and Alicia grew up there with Spanish as her native tongue. Thanks to the river, her experiences were largely agricultural, with a diet supplemented by fish, chicken, hogs, goats and deer. Chasing chickens was fun, but Alicia had dreams of something else.

After working as a teacher’s assistant and striking that one off the list, she ended up with an associate degree in business and computers and was able to work in retail for a few years. Then something dreadful happened, and the painful memory lives on to this day. Alicia’s only son became ill in 2001, and soon the dreaded diagnosis of severe aplastic anemia rocked the family. There was a temporary ray of hope because her 8-year old daughter was a perfect match for a stem cell transplant, which happens in about 1 in 4 cases. However, her son died after the transplant due to lung complications, just two months after diagnosis at the age of 14.

Sometimes tragedy can be a catalyst for change. It was during this trial and afterward that the thought of being a nurse came into Alicia’s mind and heart. She had seen some good nursing and some not-so-good nursing and was convinced that she could become a good and compassionate nurse. According to Alicia, “God insisted to make me understand my mission, as painful as it was.”

She didn’t like to see pain or blood, and English was her second language, but she kept pushing herself, and that brought her to where she is today. Alicia became an oncology-certified nurse in April 2012 and has been a consistent presenter and participant at the annual regional Oncology Nursing Symposium since that year. Along with other oncology nurses, she served Thanksgiving and Christmas dinners to the local Hope Lodge residents from 2012 to 2019. Our Hope Lodge, sponsored by the American Cancer Society, provides lodging to a large number of patients with cancer and their families who live 40 miles or more from Lubbock, Texas. 

She worked at the Covenant Medical Center in Lubbock for about five years, was involved with hospice nursing for about one year and came to the Southwest Cancer Center (SWCC; now UMC Cancer Center) and the University Medical Center, or UMC, in 2011. She has been a part of eight committees here and has received numerous awards, including the UMC All-Star of the Month, Guardian Angel Award and Employee of the Month, all in 2015, and the Guardian Angel Award again in 2016. Most impressively, she was named the SWCC Nurse of the Unit for 2014.

At our cancer center, she focused on chemotherapy administration for about two years, and then Alicia used her excellent bilingual skills as a patient and staff educator for about two years. In June 2015, she became our assistant director of nursing and a clinical educator. Two years later, Alicia became the community outreach coordinator for our center. In a curious life twist, she didn’t enjoy teaching at the beginning of her career and yet has been quite a teacher for the past six years.

What is it that she treasures the most about her nursing career? In Alicia’s own words: “When I teach Spanish-speaking individuals (about their cancer, treatments and side effects) and I see the light of understanding in their eyes, that is priceless to me.” Alicia has helped as a translator for me on multiple occasions. She speaks Spanish in a way that is effortless, emotional, expressive, thorough and accurate, and she looks into people’s eyes to see that they understand. About one-third of our patients are Hispanic, and half of those are quite fluent in English. But for the rest, Alicia’s skills are priceless.

Alicia pushed forward yet again to get her family nurse practitioner degree in May 2019. She has a new interest in cancer survivorship to add to the list of what she is already doing. On a personal note, she has been married for 33 years, and her daughter has continued the tradition of providing compassionate and excellent care as a nurse.

Alicia Castanon is always willing to go the extra mile, and for that she deserves recognition.

In this Extraordinary Healer® nomination essay, Alicia Castanon, M.S.N., OCN, APRN, FNP-C, proves herself as an exceptional teacher and oncology nurse. 

An Oncology Nurse's Mission to Teach

Dioanne, or “Jojo,” as she is known throughout the department of dermatology here at Memorial Sloan Kettering Cancer Center (MSK), came to our team about two years ago and has been loved and cherished ever since. She is 110% dedicated to the care of our patients and goes above and beyond to make sure all have the appropriate wound-care supplies, medications, and appointments.

Jojo spends countless hours doing things that are not in her job description, such as calling insurance companies to make sure there are no discrepancies or interruptions in patient care. She is a storehouse of wisdom and knowledge; with her background in acute urgent care, she was the perfect addition to Dr. Alina Markova’s team. 

She is easily one of the hardest-working and sweetest people I’ve ever had the pleasure of working with. Our patients absolutely adore her, to the point where some actually refuse to speak to any other nurses if she is not available. And whenever she’s not here, the impact is definitely felt throughout the clinic.

Although Jojo holds the title of being Dr. Markova’s primary nurse, she never hesitates to extend herself where needed throughout the department. Often during her administrative days, I get a call or email from her telling me that a doctor has pulled her into another clinic 

or that a patient wanted to see her on a different floor. She is in such high demand here that sometimes she has to try to hide out from the other medical doctors so she can get her administrative work done.

Over the past two years, Jojo has become not only one of my favorite nurses but also an amazing friend and confidant. She has made my time working here at MSK so amazing with her high energy and “I’ll get it done” attitude. I truly cannot think of anyone more deserving of recognition.

Oncology nurses are the backbone of cancer care, and here's why they are cherished by patients and fellow nurses alike.

Why Oncology Nurses Are Adored By All

During each October's Breast Cancer Awareness Month, the color pink makes its mark on everything from T-shirts to ribbons to merchandise, raising awareness about the disease and generating funds for research. Love the association with pink or hate it, the color is a reminder of the decades of patient advocacy that have brought breast cancer out of the shadows and into the public conversation and scientists’ labs.

, we look back at that patient advocacy movement and tell the story of how it began and where it has taken us. Our cover article begins in the 1950s, when the word “breast” couldn’t be uttered in public and women were not consulted before being given mastectomies. 

We follow the movement through the rich culture of advocacy that has raised billions of dollars for research and led to not only a much deeper understanding of the disease but also choice for patients about how to treat it. Today’s community welcomes a wider swath of those affected by breast cancer, including previvors who face an inherited predisposition to the disease. We hope you enjoy this feature brimming with the stories of advocacy pioneers, including Terese Lasser and Susan G. Komen founder Nancy Brinker.

In this issue, we also delve into the question of when patients with early-stage breast cancer can safely be spared surgery.


In cases of ductal carcinoma in situ, stage 0 cancer, there is debate about whether surgery is always needed and if it should be lumpectomy or mastectomy. This type of breast cancer is considered preinvasive, and the difficulty in choosing a treatment revolves around a lack of methods for predicting which cases are aggressive and more likely to recur. In our feature article, we present the latest thoughts on this topic.

A third feature explores new developments in treating breast cancer that has spread to the brain.

Elsewhere in this issue, we consider the safety and potential benefits of a shorter course of hypofractionated radiation therapy for certain women with breast cancer. We also discuss blood-based biomarkers as a way to predict the recurrence of triple-negative disease.

Five people who have metastatic breast cancer, all ambassadors for a website that provides emotional support, let us glimpse life with the disease through their eyes. In the same vein, a group known as The Breasties aims to inform and encourage younger people affected by women’s cancers, and two of their founders discuss their experiences.

We hope that this array of material is both inspiring and educational, offering insights that help you ask key questions and make solid decisions about your care. As always, thank you for reading.

October is Breast Cancer Awareness month and is deeply associated with the color pink, but it wasn't always like that. Here's how the breast cancer awareness movement began. 

A Look Back at the Movement That Changed the Breast Cancer Journey

A native New Yorker, Shira Kallus Zwebner is a communications consultant and writer living with her husband and three children in Jerusalem, Israel. Diagnosed in 2017 with diffuse large B-cell lymphoma, she's fighting her cancer battle and blogging about the journey at hipstermomblog.com

Two weeks after finishing treatment, with the after-effects of more than 8 months of chemotherapy still coursing through my veins, I drove an hour away from my city to meet with a nutritionist. She had come "highly recommended" and I yearned for someone to help my body heal from cancer, from the poison in it that killed my cancer. I was desperate to keep myself in remission and was willing to pay, do and try anything. Even in cancer debt, I was willing to shell out more than $500 that I didn’t have if it meant I would stay cancer-free.

I brought my medical records with me, the new set of blood test results she requested and my bag full of medication and supplements. We sat together for over an hour while she created a new wellness program for me, which included supplements, daily juices, exercise, and naps.

 With a full-time job and three children under the age of 9, daily naps were never going to happen.

Then she reached over her cluttered desk and took my hands, looked deep into my eyes, and promised me she would be there for me no matter what. I walked out of her office and drove straight to an appliance store to spend another $300 on a top of the line juicer that I couldn't afford, hopeful that I had found my answers. The following day, I emailed her with a question and never heard from her again.

Sadly, she was not the first person to take my money and disappear; over the past two and a half years I have fallen victim to people who preyed on my cancer vulnerabilities. I’ve met with homeopaths who promised to keep me in remission, while charging exorbitant monthly fees, and hired personal trainers who said they specialized in working with past cancer patients, but then created workout programs that left me limping and in pain. COVID-19 has just exacerbated these vulnerabilities while increasing the number of people savvy enough to prey on our fears.

Living in Israel, I have gone through two official COVID-19 lockdowns, the most recent one currently in the first stages of lifting. For the past month, over the Jewish high holiday season, our movements were restricted. Shops and restaurants were all closed, with some offering food deliveries. Families were told they couldn’t get together for holiday meals, while all beaches and nature parks were closed to the public. We couldn't walk more than 1 kilometer from our homes while gyms and other exercise facilities were shuttered. Schools were closed and children reverted to distance learning, while offices of non-essential workers were closed and many parents were forced to work from home. And during this lockdown, I had my fall scans which included an abdominal ultrasound and blood work. My ultrasound was clear but my blood work wasn’t, and as a lymphoma survivor, the results shook me to my core.

Depressed and scared about my blood test results, and the upcoming follow up tests, I spent a lot of time on social media. On Facebook and Instagram, I was bombarded by people and brands peddling their wares, services and 

. This doctor has a nine-day liver cleanse that looked promising, while that wellness guru offered a 30-day meditation package that promised to “calm, relax and heal” me.

Then I saw a Facebook post from a local photographer who specialized in boudoir sessions, who was offering a 30-minute lockdown special that looked promising. I was desperate to do anything that would make me feel better, so I got in touch to ask for more information. I soon realized it wasn't for me, but she kept following up with me. I was weak and tried to be kind, I kept telling her I would think about it. She followed up again and I told her that while it sounded so great, I just wasn't comfortable with my body. She responded that lots of people found it empowering, that the session would do wonders for my self-confidence. She used all the right words, said all the things I needed, and wanted, to hear.

I sent her payment, booked a session and days later canceled. I never rescheduled and, unsurprisingly, she never followed up with me.

When I realized that I essentially paid this woman to leave me alone, I surrendered my credit cards to my husband. Sadly, the only way to avoid falling victim is to completely disconnect. I take ownership of my weaknesses; no one forced me to sign up, pay for, or make appointments with any of these people. They just didn’t make it easier for me to say no either.

Miracle cures, juice cleanses, even ancient supplements, cancer patients and some survivors often fall victim to people who prey on our vulnerabilities from cancer.

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