Breast Cancer and Young Women

Breast cancer is traditionally diagnosed in women over the age of 55. However, it can affect women under the age of 40 years old. Fewer than 5% of all breast cancer cases in the United States occur in women under the age of 40. Being diagnosed can be very difficult and shocking for these women.

In women under 40, breast cancer tends to be fast growing, higher grade, and hormone receptor-negative. All of these mean that the cancer is more aggressive and would require specialized treatment. Treatment options may be impacted by your age and your menopause status.

With young women, experts suggest that there may be an increased risk from BRCA 1 and BRCA 2 mutations. The impact of these gene mutations are still be studied to understand what causes early-onset breast cancer. Additionally, scientists are working hard to investigate the underlying genetic factors that may contribute to risk and medical issues a younger woman faces as a result of breast cancer. Today, over $16 million is spent to understand early onset breast cancer.

There are many unique challenges and problems that these women may face. Chemotherapy may impact fertility by damaging the ovaries or by altering your menstrual cycles. Young women with breast cancer may also need to consider clinical trials for fertility preservation if traditional methods do not work.

Most importantly, young women experiencing breast cancer may need additional forms of support through support groups. Social support may be especially important for their loved ones, partners, and children.

Sources: Susan G. Komen – Young Women and Breast Cancer

Click here to continue learning about early onset breast cancer.

What is Nipple-Sparing?

Nipple-sparing is the latest in mastectomy technique. Touro Infirmary Breast Cancer Patient Valerie Leclercq underwent a bilateral nipple sparing mastectomy and breast reconstruction in May 2018. Her surgery was performed by Breast Surgical Oncologist John Colfry, M.D. Nipple-sparing mastectomy keeps the nipple and areola intact along with the breast skin.

There are many different incisions used to do this surgery. One incision is made under the fold of the breast. Other incisions begin near the areola and extend towards the outer portion of the breast. Vertical incisions from the breast fold to the nipple are also sometimes used. In all cases, all visible breast tissue is removed.

In the past this was called a subcutaneous mastectomy. No matter what incision is used, tissue beneath the nipple and areola are checked for cancer. If cancer is detected, the nipple is removed, converting the procedure to a skin-sparing mastectomy. With either surgery, breasts are then reconstructed with an implant or tissue taken from another area of the body.

Candidates for nipple-sparing mastectomy include:

  • women whose tumor does not involve the nipple or tissue under the areola
  • women whose tumors are surrounded by a clear margin of cancer-free tissue
  • women who have not been diagnosed with inflammatory breast cancer or advanced breast cancer with skin involvement

Additional questions about Nipple-Sparing Mastectomy? Give our team a call at (504) 325-2900 or visit our Touro Website to learn more about your options.

Sources Breast Cancer Organization

Click here for more information on nipple-sparing.

Dealing with Financial Toxicity on your Cancer Journey

Danielle McCullogh, RN

The moment you are diagnosed with breast cancer a whirlwind of thoughts and emotions runs through you. There is so much to process. Thoughts like: “How could this happen to me?” “I don’t have time for this.”  “What is the next step?”   What we often don’t think about are the financial hardships that can go along with this diagnosis of cancer.  These hardships are so common that they were given a name, financial toxicity. This term encompasses all of the mental, physical, emotional and social stress that is caused by the cost of cancer treatment.  This financial toxicity has a huge impact on the patient and family leading to a further decrease in quality of life. Cancer is expensive, but there are things you can do to help protect yourself from financial toxicity.

The most important thing you can do to prevent financial toxicity is arm yourself with knowledge.  The more you know about your insurance and resources, the better prepared you will be.  You can check your insurance company’s website or call them for more information about your plan. You need to know what your insurance will pay for and how much you are responsible.  You need to know what your out of pocket maximum is and know when you have reached it.  Choosing the right insurance can have a big impact on your out of pocket cost, sometimes thousands of dollars.  The tricky part is understanding how to choose the insurance that is best for you, and there are resources that can help with that decision.  A great place to start are the financial counselors at your treatment center.  Another great resource for information is The American Cancer Society.  You can call them at 1-800-227-2345 anytime.  There is also great information and instructional videos on Triage Cancer’s website about insurance basics and picking health insurance.

Once you know your treatment plan and have started the bills will start to arrive. Don’t just toss them in a pile and ignore them, stay organized. You can match the bill with the explanation of benefits (EOB) from your insurance company.  If you aren’t getting the EOB, call your insurance company and make a request.  The insurance company will send you this form and it will list all the charges the healthcare provider filed with the insurance company.  It will also list how these charges were paid, whether it was by the insurance company or if they are your responsibility.  Once you are organized you can reach out to the treatment facility and make a plan.

There are also other forms of financial support available.  There are foundations that can assist with treatment costs or household costs. Touro Foundation and Cancer Association of Greater New Orleans are both local foundations that help patients while being treated.  Another great place to receive assistance is through drug companies.  Some offer their drugs at free or reduced costs.   Ask the nurse or patient navigator at your treatment facility if these foundations or drug companies can help.

The best thing you can do to prevent financial toxicity is ask for help.  There are many resources available to you and many people at your treatment facility who want to help.

To learn more about our Supportive Cancer Center, please call (504) 897-8678 or click here.

Danielle McCullogh, RN, BSN is a nurse navigator on Touro’s Supportive Cancer Center team. She is an experienced and compassionate addition to the team and works towards ensuring that all of her patients have a support team and meaningful experience.

What is Hidden Scar?

Touro Infirmary and Dr. John Colfry are proud to offer our patients Hidden Scar™ surgeries, an innovative and empowering approach to mastectomies and lumpectomies. Through these advanced approaches, cancerous breast tissue is removed with a single incision. The utilization of this approach minimizes scarring and preserves a natural looking breast.

What are Hidden Scar™ surgeries?

Hidden Scar surgeries utilize single incision approaches to remove cancerous tissue from the breast. Qualification for the surgery depends on a patient’s tumor size, location, and breast tissue. There are two forms of this surgery that Dr. Colfry performs; a mastectomy and a lumpectomy.

With the mastectomy, an incision is made typically beneath the breast and the underlying breast tissue is removed. As a result, the nipple and breast skin are preserved. With a lumpectomy, a single incision is placed in one of three areas of the breast before the tumor and area around the tumor are removed. With this approach, the tissue of the breast that is non-cancerous remains.

Is there a difference between traditional approaches and Hidden Scar™?

Patients who undergo these approaches compared to traditional mastectomies or lumpectomies are at no higher risk of recurrence than patients who undergo any other technique.

Why would I choose the Hidden Scar™ approach?

When going through breast cancer and surgery, scars matter. Scars may have an impact on confidence, intimacy, and body image.

  • 72% of women are unhappy with the location of their scars
  • 76% of women did not realize the impact that her surgery scars would have on her when someone else sees her undressed.
  • 87% of women feel self-conscious or uncomfortable due to their scars.
  • 82% of women have not worn particular pieces of clothing due to concern or the fact that it reveals her scars.

The goal of the Hidden Scar approach to improve the emotional and psychological recovery during and after treatment. Studies show that scars may impact women negatively especially in regards to quality of life and personal views.

Additional questions about the Hidden Scar surgeries now being performed by Dr. Colfry at Touro Infirmary? Give our team a call at (504) 325-2900 or visit our Touro Website to learn more about your options.

Exercising before, during, and after breast cancer

Exercise should be an important part of your daily life before, during and after breast cancer. However, exercise during and after breast cancer treatment may look very different than how you exercised before treatment. With all exercise regimens, it is important to always follow medical advice and before starting any new exercise plan you should speak with your physician.  Here are some expert tips to help you stay healthy during every stage.

Before Breast Cancer

Exercise is important in decreasing your risk of developing breast cancer. A higher BMI is a risk factor for breast cancer and exercise can help keep that number within a healthy number. Regardless of whether you are an expert athlete or beginner, there are recommendations from researchers. For all adults under the age of 65 years old, exercise five days per week for 30 minutes each day at a moderate intensity. For someone who is a beginner, this could be a walk around Audubon Park or a round of golf in City Park, as long as your heart rate is elevated.

During Treatment

Studies show that breast cancer survivors who increased their exercise levels and exercised during breast cancer treatment, decreased breast cancer associated mortality risk by 26%. Exercise also reduced fatigue, increased energy and mood, and improved mental health.

However, exercising during treatment can be challenging. Your overall health and physical condition before diagnosis and after the start of treatment will determine your ability to exercise. It is important to always listen to your body and stop when feels best. Speak to your doctor about working with a physical therapist or trainer during treatment.

After Treatment

Once treatment has concluded, you should talk with your cancer care team to determine an appropriate plan for exercising after treatment. It is recommended that you get 30 minutes of exercise, five days a week as before breast cancer treatment. However, after breast cancer treatment you may still feel week or recovering. Start small with a few minutes per day and then move up to 150 minutes per week.

Interested in learning more about staying healthy before, during and after cancer treatment? Click here to explore the Touro Health Library website.

Sources: Susan G. Komen

Tips to Stick to Your Exercise Routine

Once your initial enthusiasm wears off, you might find it hard to stick with your exercise routine. Here are some tips to keep you motivated:

  • Make it fun. If you like to be around people, take an aerobics class or sign up for a local soccer or walking club. If you’re happier in solitude, trying walking or hiking in a park or location with a nice view.
  • Switch up what you do so you don’t get bored. Walk one day and lift light weights the next. Ride a bike, dance, take a yoga class — doing anything is better than doing nothing.
  • Make exercise social. If you make a commitment to exercise with someone else, you’re more likely to stick to it than if you’re just working out alone. Plus, you get to catch up with your friend and cheer on each other’s accomplishments.
  • Make exercise a priority. Think of exercising as a necessary part of life, like breathing, sleeping, and eating. It’s what you do to be as healthy as you can be. Schedule exercise like you do any other important activity. Put it in your daily planner!
  • Exercise first thing in the morning. If you exercise in the morning, you’re more likely to stick to your routine, according to some studies. As the day goes on, you’re more likely to come up with excuses or have delays in your schedule that can make it hard to exercise. Another bonus of morning exercise: you’re energized for the day ahead.
  • Exercise on your way home from work. If you can’t exercise first thing in the morning, working out on your way home from work is the next best thing. Make sure you don’t go home first. Once you change and sit down, it’s unlikely you’ll be motivated enough to go back out again. A bonus of after-work exercise: you melt away the day’s stress and irritations.
  • Exercise even when you think you’re too tired. You’ll probably feel better and more energized afterward. Exercise makes your brain release endorphins, which elevate your mood and make your whole body feel better. You also breathe deeply, which can make you feel calm and relaxed.
  • Keep an exercise journal. Write down the exercise statistics that are important to you: how long you exercised, how far you walked (or ran or biked), how much weight you lifted, how many reps you did, etc. Seeing your progress can help keep you motivated to achieve more.
  • Reward yourself. Set some goals and as you achieve them, reward yourself. When you’re able to walk for 30 minutes without stopping, you might buy yourself a new pair of walking shoes or a warm-up jacket. When you can put your body in Eagle Pose in yoga, your reward might be a new pair of yoga pants or a new top. Do whatever works for you!
  • Be flexible. If you’re truly too busy or feel run down, take a break. The important thing is to get back on track as soon as you can.

Source: Breast Cancer Organization

Join Team Touro for the Race for the Cure on Saturday, October 20

Join Touro on Saturday, October 20 in City Park for the Susan G. Komen Race for the Cure. The money raised helps fund screenings, provide accurate breast cancer information and more.
>>Click here for a registration form.

Why having a healthy lifestyle is important during cancer treatment

Paula Harrelson, RN

When you hear the words “You have cancer”, your first feelings are shock and a loss of control. Things happen fast and your head might be spinning. As your treatment plan is developed and you are actively pursuing a cure, it might help to focus on things that we can control in fighting the battle ahead.

The importance of a healthy lifestyle including a nutritious diet that is well balanced with all the food groups helps our bodies heal. A diet with lots of colorful fruits and vegetables, whole grains, dairy, lean protein and healthy fats nourishes us with vitamins, minerals, protein and fuel. The less processed foods are, the more nutrition that is available to our bodies for recovery from treatments. Staying well hydrated with mostly water is also necessary to help flush destroyed cancer cells, medications and waste products from our body. Dehydration can lead to extreme weakness and nausea.

To combat fatigue the American Cancer Society recommends that people receiving cancer treatment be as active as possible. This is also something we can do for ourselves. Aim to include both aerobic activities to raise your heart rate and strengthening exercises to maintain muscle mass and strengthen our bones. Always check with your doctor about an exercise program that is safe for you and start slowly to avoid injury, frustration or burnout. A more active lifestyle is not a sprint, it is a way to live healthy moving forward. You don’t have to buy fancy equipment, join a club or spend money on clothes. There are a lot of ways to increase your activity such as walking, taking the stairs instead of elevator, gardening, housework, etc. Also check out You Tube classes, events at the YMCA, NORD or your local library. Ask  your insurance company if they provide a gym membership. Be creative and try something new.

Finally, we can take care of ourselves by practicing good sleep habits and reducing stress. Turn off electronics an hour before bed. Establish a nightly ritual such as a warm bath, hot caffeine free tea, reading or listening to inspirational stories, music or meditations. Make your bedroom a cozy and comfortable sanctuary for rest and healing. Work with your family to find stress reduction techniques that help you cope. Ask for help, seek counseling (often free through your doctors clinic). Pursue yoga, mindfulness practice, prayer, support groups, etc. Take advantage of the supportive care that surrounds you as you live this journey.

If you would like a consultation with a nutritionist, psychosocial counselor, cancer rehab exercise specialist or cancer survivorship nurse, please ask your doctor or nurse in the clinic. You are not alone in this and there is much that you do control during your treatment and after as you move forward.

>> Click here to learn more about the Cancer Survivorship Program at Touro.

Paula Harrelson, RN has over 30 years of nursing experience. After experiencing a diagnosis of breast cancer herself in 2003, Paula was inspired to dedicate the remainder of her nursing career to working with others diagnosed with cancer. As Touro’s Survivorship Coordinator, Paula is passionate about helping people address their needs and regain and sense of wellness to move forward with living. 

What to Eat During Cancer Treatments

Nutrition and eating healthy is an important part of maintaining your strength while undergoing breast cancer treatment. It is important to continue to eat well in order to get the nutrients your body needs to stay strong. During your treatment, your diet or appetite might change. There is no exact way to predict how you will respond to your treatments.

Women who have gone through breast cancer treatment have the following suggestions:

  • Take multivitamins, especially if you are struggling with appetite. Before you start one, check with your doctor.
  • Keep foods handy that are individually packaged and quick
  • Choose nutrient dense rather than calorie-dense
  • Buy in bulk so that you don’t have to go to the store when you don’t feel good
  • Talk to a registered dietitian for food advice

If you are suffering from side effects such as nausea and vomiting, consider the following when looking for food options or advice:

  • If you are nauseous, try rinsing your mouth before and after meals
  • After eating, sit up or lie back with your head raised for at least one hour
  • Eat cool foods like non-fat yogurt, fruit juice, or sherbert
  • Don’t eat foods that are very sweet, greasy or fried
  • Flat ginger ale or ginger chews may settle your stomach

If you are immune-compromised or your doctor tells you that your immune system is weak, certain foods to avoid include:

  • Raw vegetables or fruits
  • Raw eggs
  • Unpasteurized fruit juice
  • Tofu in water

Seem overwhelming? Touro can help you to learn and prepare for your diet during cancer treatments. The Touro Supportive Cancer Center has a Clinical Dietician on staff to help assist patient through good nutrition and advice. To learn more about her and her services, click here.

Sources: Breast Cancer Organization

Should a nurse navigator be part of your cancer team?

Your cancer care team will be important during the diagnosis and treatment of your breast cancer. In fact, it can seem like your team is extensive and overwhelming. You might have radiologists, surgeons, reconstruction specialists, nurses, anesthesiologists, oncologists, and pain management specialists. But one of the critical team members of your cancer team is a nurse navigator.

What is a nurse navigator?

A nurse navigator is medical staff member that is a patient advocate and who’s primary responsibility is to assist their patients with the diagnosis, treatment, and education about the cancer. From the moment that you receive your diagnosis, your nurse navigator can help to educate you about the disease and treatment option. By serving as educators, they ensure that patients understand what the treatment is and can offer emotional support and options for support groups. Your nurse navigator can take on a more administrative role as well, by addressing issues that may occur like transportation, scheduling appointments, or understanding insurance costs.

Why is a nurse navigator important for my care?

It is hard to go through breast cancer. Nurse navigators are a continuous resource for you to use and to make the system a little less complex. Unlike a physician who may be involved with just one aspect of your care, a nurse navigator will continue to provide help and support during your care.

Where can I find a nurse navigation team?

Touro Infirmary is proud to have a nurse navigator on our Supportive Cancer Center team. We believe that it is a positive and important addition to our comprehensive cancer care. Danielle McCullogh, RN, BSN, is an experienced and compassionate addition to the team and works towards ensuring that all of her patients have a support team and meaningful experience. To learn more about our center or to work with our Nurse Navigator, please call (504) 897-8678 or click here.

Coping with Breast Cancer

Vera Deluca, LPC, LMFT

A diagnosis of breast cancer affects women in many ways.  You may feel as if your life has been turned upside down and immediately have so many thoughts and emotions rush over you.  Adjusting to that diagnosis can be difficult as you are forced to cope with the physical, emotional, social, and financial effects of cancer and its treatment. Once the initial shock wears off, the process of making changes begins. Some things in your life may have to be rearranged as you start treatment. The symptoms and side effects may take a toll your body physically and emotionally and you will be forced to adjust to all the new issues that cancer brings.

A diagnosis of breast cancer can bring varying levels of emotional distress for women and some may experience more emotional distress than others.  Common emotions expressed are sadness, anger, grief, worry, fear, guilt, stress, loneliness, anxiousness, hopelessness, and helplessness.  Leaning on your support system can be helpful when adjusting to these emotions.  Whether it be from family or friends, support groups, professional counselors, religious groups, your cancer health care team, or others, everyone can benefit from help and support when adjusting to an unplanned event such as having cancer. Still, coping with your emotions may be difficult and you may need to find new ways to cope during this time.  Some effective coping strategies when adjusting to cancer are relaxation and meditation, setting personal goals and reviewing priorities, spiritual health through prayer and faith, and maintaining a healthy lifestyle through diet and exercise.

Adjusting to the physical changes can also be challenging during treatment for breast cancer and you may be able to utilize some of the same coping skills to help adjust to them. Common physical changes are hair loss, weight changes, scars, skin changes, pain, and fatigue.  Some of these physical changes are temporary while others may last longer.  Either way, your looks may be a big concern during or after treatment and body image issues may develop. Identifying the right coping skills will help you adjust to these changes.

It can seem overwhelming at first but knowing what to expect may help you feel more at ease. Asking questions and talking to your healthcare team can help you get the information you need and help your treatment team refer you to the appropriate resources. Having a support person with you at appointments can be very helpful. This person can help by listening, taking notes, and asking questions.  Being informed will help you to understand your cancer and know what the treatments and potential side effects may be.

There are many ways to help you cope with breast cancer and the many changes to your life that may arise during your treatments.  Every person copes with distress differently and will have to find what works best for them to facilitate a healthy adjustment. Developing coping skills will help you feel prepared to deal with the various stressors brought on by cancer and can be utilized before, during, and after treatment.

Click here for more information about Touro’s Support Group.