Category Archives: Breast Cancer Awareness

The Great Mammogram Debate | Another Year, Another Issue

Screenshot image from JAMA video.

Screenshot image from JAMA video.

Last fall when I sent the kids back to school, I took a little time to jump into the mammogram debate. A paper had just come out in the journal Cancer indicating that looking at a preponderance of data with the proper statistical analysis showed that mammograms do, in fact save lives. Worth reading if you’re new to RLC or just don’t remember, like me. I re-read it in preparation for writing this post. Loved the prophetic foreshadowing near the end: Somehow, I doubt this will be the last word in the great mammogram debate.

Not the last word, indeed. Just over a year later, the Journal of the American Medical Association published a new paper on mammograms, leading the American Cancer Society (who publishes the journal, Cancer, referenced in that last post, by the way) to change their recommendations for mammography. For a quick and easy overview, JAMA made this video. It is definitely worth the four and a half minutes it takes to watch it, and be sure to watch it with the narration, too.

This debate is a tough one, and I feel like everyone and their brother has already weighed in. The JAMA piece points out that the decision of who gets mammograms and how often involves the delicate balancing of benefits and harms, not unlike most medical diagnostics and treatments. They boiled down the significant potential harms to two categories: anxiety of false positives and overdiagnosis/overtreatment.

Screenshot images from JAMA video.

Screenshot images from JAMA video.

The Washington Post published an excellent opinion piece on the first issue. The title read simply: Don’t worry your pretty little head about breast cancer. That pretty much says it all– Marissa Bellack eloquently and with historical references pointed out the fallacy that has existed throughout time that women are too fragile to handle such anxiety and would somehow be better off not knowing about an actual life threatening diagnosis if it meant avoiding the anxiety of awaiting results that might come back with no evidence of cancer. The “don’t worry your pretty little head” line is perfect, exposing the ridiculous notion that avoiding worry is a valid reason to forgo screening that has been demonstrated to prolong life.

The second issue, overtreatment and overdiagnosis, is the only real consideration in my mind. It is the notion that mammography is so good that it finds tumors that are so slow growing and indolent that they would never spread to threaten the woman’s life. This is not a failure on the part of mammograms, rather, it is a failure on the part of research. Increasing research is focused on distinguishing which tumors will be the aggressive, progressive, life threatening tumors, and which would stay tiny and live happily contained to a woman’s breast until she dies of something else as a very old lady. The ACS conclusion is that biennial (every two years) screening after 55 will combat this problem, so that mammograms will note the difference in the fast growing tumors. Even though this recommendation is supported by data, it makes me pretty nervous. This is a place where I think bench and clinical research are going to need to step up, research is going to be our only way to really conquer the problem of overtreatment in early cancer or even pre-cancerous breast lesions like DCIS.

So what to do, my friends? To all my young friends who have asked, I refer you to my reflections from the Society of Women’s Health Research Meeting I attended where I learned so much about 3D mammography. I don’t disagree with the data presented by the JAMA paper (or the data collected by the USPTF, which doesn’t recommend mammography until age 50) that show little benefit in the youngest population of currently screened women. They have amassed and evaluated a huge collection of data to reach these conclusions. BUT this huge collection of data obviously took a lot of time to collect, which means that it is made up almost entirely of patients receiving traditional mammograms (and many of them even the old school film variety, at that).  What I learned at the SWHR meeting taught me that 3D mammograms do a much better job of finding tumors often missed by traditional mammography in women with dense breasts, which are more likely to be found in younger women. I think once there is a large data cohort of young women analyzed exclusively with 3D mammography, we will find benefit in screening that population as well. Incidentally, 3D mammography also reduced the call backs for additional diagnostics, thus reducing all the worry form those ladies’ pretty little heads about something that ends up not being cancer. So, young friends, I say pay your fifty bucks and keep on getting your 3D mammograms.

Yes, I think looking at the data is a good idea. But one must realize that the limitations of the data (not looking at 3D mammos in young women) and realizing that overly paternalistic (don’t worry your pretty little head) conclusions can not only lead to significant confusion, but also to the missed diagnosis of significant disease. Yes, I’ve had young friends– at least two just this month– who have gone through the stress of a false positive from a routine mammogram. But I also have young friends who are alive to raise their children because an aggressive tumor was treated after discovery on a routine mammogram. Anxiety while awaiting the results of what turns out to be nothing sucks. Know what sucks worse? Dying too young of something that could have been treated if anyone knew it was there in time.

*I forgot to even mention the clinical exam guideline. That got dropped from most recommendations a while ago because there was not clinical evidence to show its benefit. That said, I think most docs are still going to do it at your annual OB/GYN exam because they keep talking about the other stuff they’re supposed to cover while they’re doing it. I don’t consider it to be a big issue, except perhaps a sad commentary on the fact that doctors have so little time for patients that they can’t spend the extra 30 seconds on that kind of exam…

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Breast Cancer Awareness | Middle School Style

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So apparently my sweet girl and some of her friends decided that they would all wear pink today. Because breast cancer.

Probably everyone reading this knows I’m not much into pink for the sake of pink. Another thing I’m not into? Crushing the good intentions of an eleven year old with my anti-pinkwashing angst.

And so (I hope) I made the best of the situation and explained awareness without action is a little empty once everyone is already aware. Since middle schoolers don’t need to head out for an annual mammogram, we decided to look for something that middle schoolers could do. We brainstormed some ideas of things kids could do if they knew someone with breast cancer or if a friend’s mom had breast cancer. We talked about it Wednesday, but then I didn’t prompt at all when she was making the poster last night. Things like “bring them dinner,” “watch their kids” and “talk about things you would normally talk about” were on her list of how to be a good friend in a tough time. Part of me hated helping her make that giant pink ribbon. But if I learned one thing last October, it’s that the pink is already there, I might as well make it work. So today, bedecked in the fluffy pink skirt that I made for her years ago along with pink leggings and pink fringe boots, she shared a poster with her homeroom class to help them understand how to help a friend whose family has been affected by cancer. And I couldn’t be prouder.

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Big Week | CURE Magazine and Scary Mommy

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I know this probably isn’t news to those of you who follow me on Facebook and Twitter, but in case social media’s just not your thing, I thought I’d put an update here, too…

Monday my first post went live on the CURE Magazine’s online community! CURE Magazine is resource for cancer patients, survivors, and caregivers. You can pick up a copy in an oncologist’s office, and they offer free subscriptions if you fill out the included subscription card. I’m not in the print version (yet! One can always dream!) but they approached me a few weeks ago to contribute to the online community of writers, and I couldn’t be more thrilled. Being part of this publication means that people who truly understand my point of view or might benefit from my experiences will be the primary audience, and that’s huge! The piece that I wrote for them this week is a brand new piece– The Indignity of Breast Cancer. Though I’ve never been to New Orleans in March, it’s a little story about how I’ve earned more than 100 pair of Mardi Gras beads the good old fashioned way! (And why I’m totally ok with that.)

Wednesday I was featured on Scary Mommy, a collective blog that’s described as “A parenting website for imperfect parents” and “is intended for people who have a sense of humor, an appreciation for sarcasm, and wear panties that don’t easily get in a wad.” Sometimes irreverent but always funny, I enjoy reading so much of what they feature. They picked up my post from a couple weeks ago– “Ten Things Breast Cancer Taught Me” and republished it this week with a really cheesy stock photo of ladies wearing pink shirts. But still, they published it! Though they may not be my target cancer-y audience, they have a huge readership, so being featured on their site was super cool!

I’ve posted links on the right– the blue CURE Magazine logo will take you to my community page, so as I post more there, it should link to a list of all my articles there. And even though there’s just one Scary Mommy post, I’ll probably leave their signature crown up forever because it’s so cool! If you haven’t read them already, check them out!

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Three Years and Counting | The Great Post-Chemo Pixie Growout

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It’s been a while since we had a hair post, no? Since it’s been three years this week since my diagnosis, I thought it might be fun to see how my hair has changed each October…

  • October 2012: That’s how my hair looked when I was diagnosed. Gorgeous, right? I know they were all just being nice, but at one point I thought I was going to cause physical harm to the super sweet nurse who must have been the twelfth medical professional that week to tell me that my hair was beautiful. It was all I could do not to remind them that I was there because I had been diagnosed with breast cancer. I mean, they all got that it was about to fall out, right?
  • October, 2013: Just six months of growth after chemo and it was so dark and stylish! Instead of words like beautiful, people now told me that I looked strong and fierce. Man, I loved that hair, and I loved being strong and fierce! It’s funny how people assume things about your personality because of the way you choose to wear your hair. (And I loved feeling like I could pull off such dark lipstick–that Nars 413BLKR, was a go to back then!)
  • October 2014: I snapped this before heading off to a conference on 3D mammography. That was admittedly the start of a rough hair year. I had to fight the weather girl vibe on a daily basis and eventually went to a flat-ironed spiky look most days to avoid the over rounded coif that my hair apparently prefers.
  • October 2015: The light at the end of the tunnel! I’m pretty sure I had my hair like this once on purpose! It’s still a little short to get into a ponytail without too many little clips holding in stray pieces, but it’s pretty much a normal hairstyle for me now. I don’t hate it every minute of the day, and that’s major progress. It’s lightened up, too, thanks to time spent outside with the kiddos and my running buddies.

I guess I have to count it a win that I was happy with my hair in three out of four pictures… I’m on my way back to the first ‘do. If I ever make it, please don’t tell me that it’s “so 2012.” I think my family would still love for me to get back to the old pre-cancer me for a while, and I’m finally close enough that it seems possible. I just hope they don’t totally revolt when I decide I’ve had enough of the blow outs and curling iron and chop it all off for the 2013 look. But who am I kidding? At that point, they can revolt if they want. Because the next time a huge pile of my hair ends up on the floor, it will be by my choosing, and I think I’ve earned the right to pick my own hairstyle!

Thanks to Sally Brewer for the 2013 picture and Crystal Hardin for capturing the 2012 image just two days before Dragan shaved my head.

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Ten Things Breast Cancer Taught Me

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Three years ago, I went from being a scientist and stay at home mom to a breast cancer patient in what seemed like a heartbeat. Chemo and a double mastectomy with reconstruction have taught me a few things that doctors never could. If I could go back three years, this is what I’d tell newly-diagnosed me…

  1. You will get over your modesty very quickly. I’ve never been part of a flash mob, but I’ve definitely flashed enough people to constitute a mob! Best estimates are that I’ve flashed well over 100 people since I was diagnosed. (Yes, I counted.) My body went through so many changes during my treatment for me to share with professionals and curious friends alike. There was the port– the weird alien-like device implanted under my skin to deliver my chemo meds, my mastectomy scars and drains, final implants and even my first tattoos– trompe l’oeil nipples!
  2. You will be in awe of how much you are loved. Your family, close friends, friends you haven’t seen in years, people you don’t even know will rally to support you in ways you could never imagine. They’ll bring you meals and watch your kids.You’ll return home to find cupcakes and magazines with thoughtful notes on your doorstep. Your days will be filled with coffee dates, and your friends will fight for the opportunity to join you at a four hour chemo appointment. Your out of state mom will send you a fabulous pair of flats to wear to chemo because she knows your love language is shoes. You will be overwhelmed with gratitude.
  3. You will see breast cancer everywhere you look. Remember when you were pregnant and it seemed like every woman you saw was pregnant, too? Especially if you share my extreme misfortune and are diagnosed in October amidst breast cancer awareness month, you will see pink ribbons everywhere. At the grocery store, they’ll ask if you want to round up to donate for breast cancer. You will fight the urge to tell them that you gave at the office. Or that you’re giving two breasts and a full head of hair. You’ll keep your forty-two cents, thank you very much. Instead, you’ll probably just smile and say, “Thanks, not today.”
  4. You will learn that immediate reconstruction is not immediate. I remember thinking how great it was that surgeons could completely reconstruct a woman’s breasts at the time of a mastectomy. I didn’t realize that “immediate reconstruction” actually means “starts at time of mastectomy and finishes with at least one more surgery sometime in the next year or so.”
  5. You will become obsessed with other women’s breasts. Once you’ve had a breast surgery or two, you kind of forget what normal breasts look like. What you see in the mirror is not necessarily bad, in fact it may be great. But it’s not normal. You will begin to examine other women to see how your breasts compare to theirs. (You will hope they don’t notice this.)
  6. You will talk about things like drains, mouth sores and nipple tattoos all the time and in the strangest places. Like new moms form an instant bond discussing the trials and triumphs of new motherhood, you have an immediate connection with anyone who’s been through a breast cancer diagnosis. You will also have these chats with everyone from your neighbor to your dental hygienist to an elderly stranger at Starbucks, because when you’re bald, these kind of things just come up.
  7. You’ll wish you had more pictures. No, really. Nothing reminds you of how far you’ve come than seeing where you started and where you’ve been. Plus, pictures smiling with your kiddos, spouse, or friends are a great reminder of how much you’re loved.
  8. You will find that you didn’t realize how important breasts really are, even if you’re done using them to feed babies. Your surgeon will tell you early on that you won’t have any sensation and you will nod, thinking of nothing but getting rid of the cancer. You won’t realize the significance of losing sensation. Not so bad not to feel the needles of the tattoo artist recreating your nipple. Sometimes devastating not to feel the gentle touch of a husband’s hand or a child’s nuzzle.
  9. You won’t need to wear a bra! You may think you will anyway, but since it’s tough to find one that fits, you will likely get used to going braless pretty quickly. Your BFF will probably insist that you try on every strapless and backless top that you see when you’re shopping “because you can.” (And you will totally rock them!)
  10. You may never again have “just a headache.” Every little ache and pain will make you think your cancer is back. Hip pain? Cancer. Menstrual cycle two days short? Cancer. Forehead pimple? Obviously cancer. BUT, you will get used to it. You will be surprised when you go an entire day without thinking about cancer, or when you forget to mention to a new doctor that your nipples aren’t real. Yes, you will be different, but you will get used to the person that you are.

The most sobering thing I learned is that roughly 30% of women diagnosed with early stage breast cancer will develop a recurrence– metastatic disease– that will ultimately claim their lives. While women with breast cancer are living longer and stronger, 108 women still die of breast cancer EVERY. SINGLE. DAY. The patient in me wants you to understand the personal side of the disease, but the scientist in me wants you to know that women with metastatic disease are depending on the breakthroughs that medical research provides to keep their lives from being cut tragically short.

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Summer Writing | Women’s Running Magazine

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I can hardly call it writing, but the next summer project on my list just showed up on newsstands! The first thing I did when I got a request this summer from Women’s Running magazine was call Sally to make sure that I was right– this is a legit magazine! Like one you can buy in stores and everything! They asked to feature me in their “Bloggers on the Run” series for October. Because breast cancer. Ironically, they took the text from some interview questions they asked me, and there is no mention of breast cancer in the piece! But since it’s sprinkled in between pictures of women showing off their pink running gear and pages of ads featuring pink ribbons, I’m guessing anyone who’s interested will make the assumption. I didn’t really get to share anything new or shocking, but it was fun to see my face (on a bald head, no less!) in a running magazine (who’d have ever guessed?!?) and perhaps it will give a runner facing chemo the confidence to keep on running. Head to your newsstands and check it out or read it here! (I picked up my copy at Barnes and Noble, since the selection at my local drugstore was too small to carry anything not related to home decorating or fashion and makeup!)

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We Heart a Great Fit | Nordstrom and the Young Survival Coalition

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It’s no surprise to most of you that I’m quite a fan of Nordstrom.  Their customer service, for one, is top notch, and that’s a big deal to me.  I’ll never forget the time that the gentleman in the shoe section was tracking down a pair of shoes for me at another store since he didn’t have my size.  It was taking a long time, so Sally and I wandered over to the lingerie section and were shopping there when he finally got it all taken care of.  He came over and found me and placed my order right there, at the “unmentionables counter.” (bonus points if you can name the movie reference for that one.)

Needless to say, after my first trip to the unmentionables counter at Nordstrom, I was a convert, never to return to the land of Victoria and her secret.  The women at Nordstrom know what they’re doing, and they will make sure to get you into a bra that fits you.  This weekend, they are partnering with the Young Survival Coalition for a fitting event, and will donate a portion of the sale of certain brands (I can’t remember now, but there are several– it’s not like you have to buy that one outrageously pink bra if you want to be part of the event!) to the Young Survival Coalition, which addresses the unique needs of women who are diagnosed with breast cancer before the age of 35.  (I was barely 35 at diagnosis, but apparently, I make the cut!)

I’m pleased to be a part of the campaign for a bit on Friday morning, and will be at the Nordstrom in Tyson’s Corner.  I’ll talk to the staff there and probably stick around and answer any questions that they or any shoppers might have.  I can see where having a pink-hued bra fitting event for breast cancer might seem like just another Pinkwashing kind of thing.  But, I have learned that the “pink” opens some doors, and so it would be silly of me not to seize that teachable moment to encourage women to make smart health choices and have a better understanding of breast cancer.

So for the details: the event runs this Friday and Saturday, October 24-25.  I’ll be at the Tyson’s Corner Nordstrom starting at 10am.  Not sure how long I’ll be there, if you might stop by, let me know!

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Metastatic Breast Cancer Awareness Day

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You probably all know that I’m a little weary of breast cancer awareness in general.  We are past the days of Betty Ford when the words “breast cancer” were spoken only in a whisper.  People know what breast cancer is. I think a lot of people know that because of early detection and improved treatment regimens, the outlook for women facing breast cancer is no where as grim as it once was.  It turns out, though, that all the pink and all the survivors have perhaps done the breast cancer community a bit of a disservice.  When you know far more women living after breast cancer than those whose lives have been claimed by it, it’s easy to think that it’s not such a big deal.  It’s easy to think it’s not so deadly.

And yet, there are nearly 150,000 women (and a few men, too) living right now with metastatic breast cancer.  They are in the never ending cycle of scan, treat, repeat.  That’s right, they will be undergoing breast cancer treatment for the rest of their lives. Lives that will likely be cut tragically short by breast cancer.  While only 6-10% of women present with advanced (metastatic) breast cancer, nearly 30% will likely have a recurrence, putting them into that dreaded metastatic category.  Treatment advances since the 1970s have increased the median survival time for a woman with a metastatic breast cancer diagnosis to three years, which, while not great, is at least trending in the right direction.

There are a few groups that are focused on advocating the needs and research agenda of metastatic breast cancer patients.  Monday, October 13, was Metastatic Breast Cancer Awareness Day.  The Metastatic Breast Cancer Alliance, made up of twenty-nine breast cancer organizations, released a comprehensive report on the landscape of metastatic breast cancer, focusing on issues like research allocation, patient quality of life, support for metastatic patients, proper epidemiology (currently, data are not collected when a patient has a recurrence, so it is unknown the exact number of patients living with metastatic breast cancer), and public awareness about metastatic breast cancer.  (It’s a pretty heavy read, but the Executive Summary is a little more manageable.)

Instead of reiterating all that is in their summary, I thought I’d share with you a few things I learned this week.  I came across a tweet from Pfizer which had the staggering results of a survey they conducted:

pfizerI was shocked to see that 72% of people think that advanced breast cancer (by definition, that’s stage IV or metastatic disease) could be cured, and that half of those surveyed thought that it was basically a woman’s own fault if she ended up with metastatic disease. For the record, once breast cancer is considered advanced, it’s not curable.  Current treatments aim to control quality of life issues, and are considered successful if the cancer doesn’t get any worse. Maintenance without progression is the goal.  While many women can live years in this “maintenance without progression” zone, they will likely die as a result of their metastatic breast cancer.  In addition, those who progress to stage IV disease, sometimes within a few months of the cessation of treatment, sometimes more than ten years later, are not responsible for their progression. Many of that 30% had tumors that were caught early and treated aggressively.  Figuring out who will progress and why is a huge deal– a very present research need that some are beginning to address.

The other thing that I learned probably has a little something to do with those statistics.  Hopping on and off twitter on Monday, I saw a lot coming from the metastatic community.  Tweets, blog posts, chats.  My overwhelming impression was that many of these ladies feel isolated and marginalized by all the “pinkness” of October. They feel like they don’t fit in with all the messages of hope, knowing that they face the reality they will not “conquer” their disease.  They have an understandable urgency for mets-focused research, and many find awareness for awareness’ sake just plain offensive.  They’re not so much interested in all those #SaveSecondBase, #TouchYourTaTas, or #NoBraDay campaigns. They want people to understand that metastatic breast cancer claims nearly 40,000 lives every year, and more research money needs to find a way to stop it.

I was touched by the passion of these women to educate and advocate, knowing that their lives will be cut short by breast cancer.  Again, this seems like a time when a little selfishness is in order.  Yet they argue with passion for research money that will doubtfully be able to save their lives.  They write, chat, and speak in public in between chemo appointments or based on the schedule of when they’ll be feeling their “best.” Surely they deserve our utmost respect during a month that many women who’ve been through breast cancer, either in active treatment or with no evidence of disease, find so very difficult.

 Images via MBCN and Pfizer

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The DC Ladies Interview

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Do you read the DC Ladies? It’s a fun lifestyle blog for women, by women, in the DC area.  I love their tagline: the most fabulous women in the most powerful city. So I feel just a little fabulous today to be featured on their site.  It’s my first online interview, and I think they did a great job with it.  Shelley’s questions pushed me to think about things in a different way, so even faithful readers here will probably learn something new, and it is such a privilege to share my story with a new group of readers.  Check it out, and enjoy your holiday Monday!

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Breast Cancer Awareness at the Pentagon | Recap #2

After the morning’s fun un-run, I headed to the Pentagon Athletic Center with a big crew from the clinic to shower and get ready to face the day.  I just love the camaraderie of a bunch of women getting ready together.  There are no pretenses– everyone can complain about their hair as they blow it out, there’s always someone with an eyebrow pencil if you’ve forgotten yours…  After a quick breakfast and a little break, we headed over to the Pentagon Conference Center where I gave my first talk of the day.  Of course, getting my talk from the laptop (which is maybe the oldest laptop I’ve ever seen!) to the screen was a bit of a challenge.  I think it took five of us to figure it out, and the conference center tech guy basically gave up and left us to our own devices before we figured it out.  Somehow it wouldn’t be a power point presentation if there wasn’t a problem with the projector.  (Those who know me well might know that I have a bit of a thing with fonts, so of course they were carefully chosen.  And of course the super old computer didn’t have the same font set, so I ended up with a few things in a rather pirate-y font.  Awesome. I’m sure I didn’t obsess over that and mention it in my talk at least four or five times.)  Once we got it going and I got over the pirate font, it went well.  The talk was open to anyone at the Pentagon, and I was privileged to have the senior staff from the clinic and the head of the Breast Care Center at Fort Belvoir and her chief nurse in the audience, too.  It was a diverse audience, but I think I managed to keep everyone engaged, and there was a great discussion afterwards.

DSC_0005In the break before heading out to the courtyard, I had lunch with the ladies from the Breast Care Center at Fort Belvoir. It was so interesting to share perspectives on patient care, and it was a unique dynamic– since she wasn’t my breast surgeon, I enjoyed being able to talk to Dr. Williams as more of a colleague than in the normal doctor/patient relationship.

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The courtyard event was fun, it was filled with people in pink who were eager to share their own stories.  It was a privilege to speak with so many men and women.

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And then I see this picture.  That’s me, standing on the stage in the courtyard of the Pentagon, being introduced to the crowd by the director of the clinic.  Craziness. I don’t get nervous, and feel like I’m taking it all in stride, but then sometimes I just realize– this is a big deal!

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I gave a quick talk, a little about me and a little about how to reduce your risk of breast cancer where you can and the importance of regular screenings before encouraging everyone to join me for a walk or head out on the three mile run that we skipped that morning.

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We encouraged everyone to walk for twenty minutes.  You know, for their health.  We’ll just not talk about the fact that each lap went through the designated smoking area.  Little victories, you know? ;)

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Oh, and did I forget to mention that I got a major award? OK, that might be overselling it a tad, but I did get a lovely framed certificate lauding my contribution the the Pentagon’s Second Annual Breast Cancer Awareness Campaign and a commander’s coin from COL Pina. Very cool.  If I ever get a real job with a real office, you can be sure that bad boy is going on the wall!

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But really the best part of the day? I got to know some great people.  The clinic staff were such lovely hosts and made me feel like a VIP and part of the crew at the same time.  I spoke with several women who either were going through treatment for breast cancer or who had faced it in their past.  We traded stories and bonded in a way that’s becoming so familiar to me.  Karen tells me that she’s gotten great feedback since the event, and one of the women we talked to has even already stopped by the Fit to Win program at the clinic to start on a more proactive survivorship wellness plan.

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It was such a privilege to get to be a part of a breast cancer awareness campaign that I truly felt made a difference.  There was pink, yes, but I really feel like there was a conscious effort to embrace the teachable moment that the pink provided.  I was able to share some proactive steps a woman can take to reduce her risk of breast cancer, and I was able to incorporate some of the recent data that mammograms are catching cancers earlier.  But I was also able to use my time to remind everyone that there are no guarantees, and despite all the talk of risk reduction, early detection, and even my smile and healthy appearance, nearly 40,000 women will die of breast cancer this year. With so many healthy survivors, it can be easy to gloss over the fact that breast cancer is a serious disease. And while October, in all its pink glory, can get a bad reputation for ignoring the hard parts of breast cancer– the suffering through treatment, what it’s like to live with metastatic disease, the lives it claims– I felt like my October day at the Pentagon was well spent.

Thanks to Natalie at the clinic for the images of the day’s events.
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