Category Archives: Resources

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 That pretty much says it all– Marissa Bellack eloquently and with historical references pointed out the fallacy that has existed throughout time that women are too fragile to handle such anxiety and would somehow be better off not knowing about an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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No More #NoBraDay | Bras for Breast Cancer Survivors from AnaOno Intimates

anaono alejandra mastectomy reconstruction bra

One day earlier this month, I noticed an onslaught of the #NoBraDay hashtag on twitter.  I’m sure it started out with the best intentions– maybe like denim day where I donated $5 to some charity (domestic violence maybe, or even breast cancer?) so that I could wear jeans to work.  Perhaps the original intent was that women could forgo wearing a bra for a day if they donated to some worthy charity.  But most of what I saw were the tweets of women in the breast cancer community who found such “awareness” rather offensive.  I started the day telling someone that it didn’t offend me, but I understood that many women who have gone through breast cancer found #NoBraDay pretty distasteful.  But as the day wore on, I could feel my attitude changing.  For me, everyday is #NoBraDay, and I have only breast cancer to thank for that. That tasteless hashtag began to mock me, make me feel less like a “normal” woman since I can’t wear a bra. A year ago, I was so excited to ditch my compression bra and buy a pretty new bra for my pretty new breasts.  At Nordstrom, I tried on every bra the associate brought me– it must have taken over an hour– and I still left without a bra.  It turns out that my new breasts look fine under clothes, but they aren’t the same as natural breasts, so normal bras just don’t fit right.  I continued to search– from little boutique lingerie shops to mall shops to big box stores where I could choose my own options and try on every single size.  After a few months of disappointment, I gave up.  Just last week, I tried on a shirt, but since I could see Vinnie’s masterful work peeking through the white top, I passed.  “I’d have to wear a bra,” became a whole new reason not to buy a top I loved.

anaono mastectomy reconstruction bra rachel

Last week, the same day I returned that white top to the rack, I came across AnaOno Intimates in an article I found on twitter.  It’s a small company started by Dana Donofree, a young breast cancer survivor who was frustrated when her plastic surgeon suggested she just wear sports bras after she’d finished her reconstructive surgeries.  Trained at Savannah College of Art and Design and having worked in the fashion industry, Dana decided to take matters into her own hands, and AnaOno Intimates was born to meet the needs of women who had gone through various surgeries for breast cancer.  I immediately headed to her website which featured bras that actually look like bras and read her promise that they would really fit me.  I was oh-so hopeful, but after trying on what had to be at least a hundred bras, I worried the small/medium/large sizing wouldn’t work for me.  I filled out the contact form expressing my concerns, and almost immediately had an email back from Dana.  She asked for my dress size and the volume of my implants and then confidently pronounced me a medium.  She could tell me the sizes of the models and even other women she’d fitted, complete with details about the volume of their implants.  I could tell she knew what she was doing, and so I was giddy as I waited for my package to arrive.  I am now the proud owner of the first two bras shown here– the Alejandra (shown in black) and the Rachel (shown in ivory). The Rachel had been my first choice, I eagerly donned it as soon as I opened the package and wore it all day– I haven’t worn a bra all day without being completely irritated since my mastectomy.  But I just love the Alejandra– it fits like a dream and reminds me of the pretty push up bras that I used to wear what seems like another lifetime ago.  (Don’t let the website fool you, I almost missed the fact that the Alejandra has convertible straps– they can be worn criss crossed as shown or like a standard bra, which I prefer.)

anaono mastectomy reconstruction bra jill jennifer

The site also features several bras that I consider sportier– still very pretty but reminiscent of a racerback sports bra.  They’re not likely to be my go-to, but for women who have had a lumpectomy or a mastectomy without reconstruction, these bras are genius. The light stretchy fabric and racerback shape makes them a great fit even when there is a substantial size difference between breasts.

anaono mastectomy reconstruction bra kelly 3

I have to admit that the ability to go without a bra is a pretty big perk (couldn’t resist the pun!) most days, but I found the inability to find a decent bra surprising and such a disappointment. I guess for as much as most women complain about it, there is something so inherently feminine about wearing a pretty bra, and I didn’t like that the option had been taken away from me. I’m so glad that now when I want to wear a pretty bra– or even just a plain white tee– I can head confidently to my lingerie drawer, knowing that I have some lovely options.

I know October is almost over, but through the end of the month, you can save 10% on your purchase at AnaOno by entering the code WARRIOR10.

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Cancer Vixen | Breast Cancer Book Review

cancer vixen

When I was diagnosed with breast cancer, several well meaning friends and family members gave me breast cancer books.  They were such thoughtful gifts, and I really did appreciate each one.  They were mostly the kind of books that had soft images of flowers on the front, they were probably really touching, inspirational, and encouraging.  I’m not sure because I only read (most of) one of them.  Somehow they didn’t scream “entertainment,” and that’s a pretty important component of any book that’s going to hold my attention long enough to finish it.

The day I had my head shaved, I first met the woman I consider my “cancer mentor.” She had finished treatment about six months before, and had tips, advice, and could commiserate over pretty much anything I wanted to discuss.  She has a great sense of humor, so when she suggested a book, I was all in.  Cancer Vixen didn’t disappoint.  It’s hilarious, a little irreverent, and so very true.  Any time a book has a magnification of little green cancer cells giving you the finger and mentions several new MAC lipstick shades I need to try, I think it’s a win. There were so many things to which I could relate.  It’s like it’s the book I would have written.  If I were an artist.  A funny artist.  A funny artist living a fabulous life in New York City.

I didn’t really want to read anything insightful, heartfelt, or inspiring.  I wanted to commiserate with a funny friend who knew just what I was going through.  Plus, anytime I can think of myself as some sort of super hero, and a vixen to boot, well, that’s a good thing.

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Red vs. Pink | Baseball and Breast Cancer Awareness

Pentagon breast cancer awareness Jamie HollowayAh, October. Growing up in St. Louis, the end of September was filled talk of magic numbers and the upcoming pennant race.  To support our beloved Cardinals, the streets were a sea of red.  October was all about baseball and red.

I did don my Cardinals jersey this afternoon as the redbirds clinched the pennant, but the lead up to October has been a bit different this year.  Instead of baseball and all things red, I’ve been reading all my brain can handle on breast cancer and I actually bought a pink dress.

I’m starting off October with a bang– four events in two days!  I’m so honored to be working with the DiLorenzo TRICARE Health Clinic at the Pentagon for their Breast Cancer Awareness Campaign. The overarching goal of each of the events is to encourage women to maintain a healthy lifestyle to reduce their risk of breast cancer and to remind women that early detection through screening saves lives.  This Friday is my big day, which starts at 0530 with a run with the military staff at the clinic.  For you non-military types, 0530 corresponds roughly to oh-dark thirty, which is to say, 5:30.  AM.  And I will likely be the only civilian. No pressure there. After a quick shower, I’ll throw on my new pink dress and give a talk that’s open to anyone at the Pentagon, sharing a little about myself and some friendly tips for patients, survivors, caregivers, and providers.  I’ll have another quick breather before the big event in the courtyard of the Pentagon, where I’ll reinforce the themes of the day and kick off a walk around the courtyard.  Representatives from the Breast Health Centers from Walter Reed and Ft. Belvoir will be there to answer any questions and encourage women to set up screening appointments.  That will wrap up my day, and while I’m sure I’ll want one desperately, I’ll bet there won’t be time for a nap before I have to head to the bus stop to pick up the kiddos.  I’ll also be heading over a couple of other times to give the nursing staff a patient’s perspective and to share some of the recent news from breast cancer research and clinical studies with the clinic’s doctors.

I was definitely a bit nervous when we started talking about all that would be going on this week.  But then I realized this is exactly the kind of thing that I want to be doing.  I’ll be bridging a gap between scientists, patients, and physicians. It’s a lot all at once, but I feel like this is something that God has really worked out for me.  It’s all right here, I just need to prepare and go for it.  I’m ready.  Three out of four talks are finished, I’ve been faithfully running, and I am now the owner not only of a pink dress, but also a pink running shirt.  Thankfully, the Cardinals are once again vying for a World Series spot, so I’ll get to rock my red, but this year, there will be a healthy dose of pink thrown in there, too.

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Online Breast Cancer Resources

image

I know that a lot of people probably come to this site looking for answers to questions after a breast cancer diagnosis.  I will be the first person to tell you to stay off the internet if you have questions– a doctor is always your best bet.  But I am also the first to admit that a lot of questions– the ones that seem the scariest of the most pressing– come just after a doctor’s office has closed for the day.  Or the weekend.  If you’re heading out to the internet, please, please, please check the source.  All internet information is not created equal.  I think you could probably find nearly everything you need in just two places.

Cancer.net is a great site curated by ASCO (the American Society of Clinical Oncologists) for patients.  Since it is designed for patients, the information is easy to understand– conversational, not overly technical.  And because it is vetted by oncologists, it has complete, reliable information. Besides offering basic cancer information, they feature a lot of articles and videos talking about everything from choosing a doctor, managing side effects of treatment, dealing with the emotional and financial ramifications of cancer treatment, and even thriving in survivorship once you’re declared cancer free.

My other favorite American Cancer Society’s page, I’ve headed there for years– that’s always where I got my breast cancer incidence stats back in grad school.  This past weekend, I was working on a project and took the time to look through their annual publication, Breast Cancer Facts and Figures.  This is a gold mine! It has all kinds of stats on incidence broken down by region, age, ethnicity… But they also have great information on diagnostic procedures, treatment plans, and pathology results.  They cover nearly every breast cancer question I’ve heard, but the kicker is that they cite their references!  This is a huge deal to science nerds like myself– not that I’m going to read every original article they cite, but when it’s important, I like being able to find the original, peer reviewed document to support what I’m going to say.

I’ve started a new Resources page here on Run Lipstick Chemo.  Links to these two pages will be there, and I’m going to include some local resources as well.  I’ll update it as I find new things to share, and I’ll do my very best to keep the standards high on that page so that you can trust the information you find there.  It’s a work in progress, but I feel like these two resources stand on their own, so wanted to give you the heads up as soon as possible.

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