A recent study found that automated analyses of CT scans for patients with breast cancer can predict which patients are likely to develop cardiovascular disease in the future.

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Posted By Staff Writer on Nov 2, 2020

The Seton Hall softball team held a breast cancer awareness month-themed practice in mid-October, bringing attention to the disease through the team’s social media pages.

The idea for the event was inspired by the connections some of the players have to people with the disease, head coach Paige Smith said.

“Women, in general, need to raise awareness because statistics are showing that we’re pretty likely to be touched by it in some way whether personal or in our close circle,” Smith said.

Because breast cancer has hit close to home for many softball players, including sophomore Taylor Soanes, the team felt it was necessary to put together this practice.

“It was very important to me that we did this practice because my mom has been affected so it was close to my heart and I liked seeing that my teammates had my back on something that I believe in and I know they believe in as well,” Soanes said.

Throughout the years, the team has always found ways to donate and raise awareness for this disease.

The idea to host this practice in pink shirts originally came from something known as the Think Pink Game that the team has done in the past, Smith said. The players wore pink shirts without numbers and gave their opponents the opportunity to do so as well.

In years past, usually during the month of October, the recreation center has also done spin classes in which the proceeds were donated to breast cancer.

Smith said she would cancel plans that the team had during that week and require them to sign up for a class to make sure her team was putting resources behind causes they believe in.

Every October, the team finds a cause to support, and most of the time it is breast cancer, Smith said.

She said she felt that the pandemic has been a good time to raise awareness for this disease because it helps her team focus on how they can uplift others.

“I think anything to take distraction off the current state of the world is good, and if you can put that energy into something that is going to lift other people, that is a time spent well,” Smith said.

The practice has also been widely promoted on social media by the team, particularly on Twitter and Instagram, because they felt it was a way to show their support and reach out to people who have been affected.

“Support from family and friends is the biggest thing when you’re going through times like this and you have cancer because it helps you through the recovery process and the battle of it,” Soanes said.

One thing that Smith said she hopes her athletes took away from the practice is that sport is always bigger than the player, especially with the absence of games.

If another awareness event comes about, Soanes said that she hopes her team has the same expectations of going all out and wants to continue planning more events like this.

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Award-winning Wirral author and breast cancer survivor Estelle Maher, who was diagnosed with breast cancer in 2019, is preparing to lift the lid on her own experience with the publication of a new book.

The Killing of Tracey Titmass is the author’s third novel and it will be officially launched during a virtual event on October 29 to coincide with Breast Cancer Awareness Month which runs throughout October.

The book, which is written in diary format, re-tells Estelle’s own roller-coaster journey of living with cancer, through the eyes of fictional character Jo Kearns and it’s hoped it will help others suffering with the disease.

Both humorous and poignant, the inspiring tale covers the raw emotions and physical discomforts associated with diagnosis, surgery, treatment and life post-cancer.

In the story Jo’s cancer tumour is given a life of its own and is personified through the character Tracey Titmass – an unwanted housemate, who has long overstayed her welcome.

Esther, says she hadn’t planned on turning her own experiences into a book.

I kept a diary because writing helped me to come to terms with my own emotions. It helped to stop my head feeling so fizzy and was to some extent, medicinal. I hadn’t planned on turning it into a book but then friends suggested that it might help others going through a similar experience.

“It took me several attempts. It sounds daft but at first I didn’t feel comfortable with inflicting cancer on a character. I know it’s all fictional but it just seemed too cruel and emotionally I found that very difficult.

“But, once I’d decided to write the book in diary format and attribute my own timeline of events to the character, it became a bit easier to write. It was more personal and all the interactions and hospital appointments are all based on true events and things that really happened to me.

“I want people to read it and not feel isolated. Many of the emotions you experience through something like this are normal and I want people to know they’re not on their own. Cancer never really goes away and learning to live with that and cope with life afterwards is an important part of the message within this book. Cancer doesn’t define you but it does become a part of your identity in so many ways.”

There will be a virtual Q&A session with Estelle on October 29 at Write Blend bookshop on South Road, Waterloo, Liverpool, Merseyside, as part of the official book launch.

Bookshop owner Bob Stone will interview Estelle during the Facebook Live session and fans will be invited to ask questions.

The book, published by Southport-based publisher Beaten Track Publishing, will be available to purchase from Write Blend and also online at Amazon. Her debut novel Grace and the Ghost is an Amazon Bestseller and also won the award for Best Spiritual Fiction Book at the 2018 Soul and Spirit Awards.  Sequel Angel’s Rebellion was published in 2018.

For more information about author Estelle Maher visit her website

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Hereditary cancer syndromes account for approximately 5% to 10% of all cancers, including those of the female reproductive organs.¹ It is important to identify patients at risk for inherited cancer syndromes to manage and prevent various syndrome-associated malignancies.

The management of women at increased risk for hereditary gynecologic cancer specifically has to take into consideration unique concerns regarding fertility and hormonal health, with the use of appropriate fertility preservation strategies and hormone therapy, according to an evidence-based review by the Society of Gynecologic Oncology and American Society for Reproductive Medicine published jointly in Gynecologic Oncology and Fertility & Sterility.²

Genetic Conditions Associated With Gynecologic Cancer

The most common conditions associated with gynecologic cancers include hereditary breast and ovarian cancer and hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome.² Other genetic cancer syndromes that have been linked to increased risk for gynecologic malignancy include Peutz-Jeghers syndrome and Cowden syndrome.¹

Hereditary breast and ovarian cancer accounts for approximately 5% of breast cancers and 10% to 25% of ovarian cancers.² Mutations of the genes breast cancer 1 (BRCA1) and 2 (BRCA2) account for the majority of hereditary ovarian, tubal, and peritoneal cancers.³

Several other pathogenic variants are associated with an increased risk for ovarian cancer but not breast cancer, including variants in BRIP1, RAD51C, and RAD51D. Other pathogenic variants that are associated with an increased risk for breast cancer without a significantly increased risk for ovarian cancer include variants in TP53, CDH1, CHEK2, and ATM.²

Lynch syndrome is associated with increased risk for various solid malignancies other than gynecologic cancers, especially colorectal cancer, with Lynch genes varying in penetrance.²

The International Federation of Gynecology and Obstetrics (FIGO) guidelines detail criteria for genetic risk assessment in hereditary breast and ovarian cancer, based on personal or family history of ovarian and breast cancer, age at diagnosis of the breast or ovarian cancer, or having a close relative with a known mutation or a family history indicative of Lynch syndrome.⁴

Management of Women at the Highest Risk for Hereditary Ovarian Cancer

Once a mutation is identified, the patient should be counseled regarding risk-reducing surgery, other risk-reduction strategies, and altered screening.

Screening: Although early detection of malignancies may improve prognosis, there are no effective screening tests for ovarian cancer, even in those at high risk for the malignancy. Transvaginal ultrasound and the cancer antigen 125 (CA 125) test may have a role in these cases.²

Chemoprevention: Several classes of drugs have been investigated for chemoprevention of ovarian cancer, but only oral contraceptives were found to potentially reduce risk for the malignancy. However, several studies have reported a possible increased risk for breast cancer with oral contraceptive in the general population and in women with BRCA1 or BRCA2 mutations.²

Risk-reducing surgery: Women with BRCA1 or BRCA2 mutations should be offered risk-reducing salpingo-oophorectomy by age 35 years or when childbearing is complete, but some countries recommend surgery at age 40 years or at an age that is 5 years younger than the youngest affected family member.⁴ Women with Lynch syndrome should be offered prophylactic total hysterectomy and bilateral salpingo-oophorectomy after the completion of childbearing, especially after age 40 years, as these measures have been shown to decrease the risk for endometrial and ovarian cancer in this patient population.²

Fertility Considerations

There are multiple fertility-preservation and family-building strategies that can be used to help women achieve their goals, including oocyte and/or embryo cryopreservation; use of donor oocytes, donor embryos, and/or gestational carriers; and adoption.²

Women with BRCA1 or BRCA2 pathogenic variants should be referred early to reproductive endocrinologists, as discussions with physicians and ovarian reserve  testing may help inform patients’ decisions on if and when to pursue fertility preservation.²

Patients have the option to cryopreserve and store oocytes and/or embryos using assisted reproductive technology. Although embryo cryopreservation is an effective strategy for fertility preservation, the success rate is dependent on multiple factors. The use of fertility drugs is not associated with a greater risk for invasive breast, ovarian, or uterine cancer in the general population. There is also no known increased risk for breast cancer with fertility medications in BRCA mutation carriers, but there are limited data on the risk for ovarian cancer in these patients.²

Additional options for parenthood include hormonally priming the uterus for embryo transfer after risk-reducing salpingo-oophorectomy. Even women who have undergone hysterectomy but who have retained ovaries can have children using their own gametes through in vitro fertilization with a gestational carrier. Uterine transplantation is still a novel procedure and its role in fertility preservation has not yet been determined.²

Embryo biopsies for preimplantation genetic testing (PGT) should be offered to carriers of known pathogenic gene variants. Analysis for monogenic/single gene defects (PGT-M) can aid in selecting embryos for intrauterine transfer and serve as an alternative to prenatal testing. However, one study found that only approximately one-third of high-risk women would theoretically use PGT-M themselves.²

Chorionic villus sampling and amniocentesis may be used to assess fetal karyotype and certain chromosomal abnormalities, but as of 2018, it is still considered a screening test primarily for aneuploidy that should not be used for prenatal diagnosis of a cancer risk gene.⁵

Hormone Replacement Therapy Considerations

Surgical intervention can result in menopausal symptoms at a young age, including vasomotor symptoms, cognitive changes, increased risk for cardiovascular disease, and osteoporosis. Hormonal therapy may alleviate some of these symptoms, but its use in patients at greater risk for gynecologic and breast cancers is controversial and limited data are available on the safety of hormonal therapy for women with BRCA1 or BRCA2 mutations or those with Lynch syndrome. As the benefits of hormone therapy may outweigh the risks secondary to premature estrogen loss, this option should be considered for women without a personal history of breast cancer.²

Nonhormonal options to reduce vasomotor symptoms include selective serotonin reuptake inhibitors, alpha-2 adrenergic agonists, dietary and lifestyle changes, and alternative medicine approaches.²

Conclusion

“Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions on reproductive and hormonal health,” stated the authors of the Society of Gynecologic Oncology and American Society for Reproductive Medicine review. These considerations include discussions about options for cancer prevention, fertility preservation and family planning, and management of early surgical menopause in these patients.

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Australia has one of the best rates of breast cancer survival in the world.
 
This is attributable in part to its breast cancer screening program, which has seen a significant decrease in the disease’s mortality rates among targeted populations.
 
Constant updates in cancer research, meanwhile, have led to growing awareness of factors that can impact risk, such as breast density and family history.
 
However, breast oncology and oncoplastic surgeon, and President of Breast Surgeons of Australia and New Zealand, Associate Professor Sanjay Warrier, believes it is important to keep striving to improve even further.
 
‘It’s not that we’re not doing things well, but can we do things better?’ he told newsGP.
 
Associate Professor Warrier is particularly concerned with women who fall outside the scope of current screening programs – namely women younger than 40, two of whom are diagnosed with breast cancer in Australia every day.
 
‘Most Australians assume breast cancer is a problem that only older women face, but that assumption is incorrect,’ Professor Warrier said.

When considering how best to address this issue, Associate Professor Warrier decided to focus on empowering young women, ideally within the high school curriculum, to carry out their own breast examinations.
 
‘It’s almost like it’s been a little bit of a taboo area,’ he said. ‘But the more informed [young women] are, the more empowered, relating to how to approach things moving forward.
 
‘So having an idea of how to approach a breast exam at an earlier age, when they’re potentially learning about other things like sex education, makes sense.’

It was from this concept that the ‘Look, lift, feel’ campaign was born. It is a phrase Associate Professor Warrier would like to see become as well known as SunSmart’s iconic ‘Slip, slop, slap’.
 
‘The idea is to have a campaign relating to assessing the breasts without it being overly cumbersome, in a way that’s easy to remember,’ he said.
 
‘This is a process I would like to see become ingrained into the lives of women all over the world, from an early age. The earlier the detection, the better.’
 
Self-examination is especially important among young women for a number of reasons.
 
‘Breast cancer in young women can be more dangerous than breast cancer in older women,’ Associate Professor Warrier said.
 
‘This is because young women’s breast tissue is usually denser than the breast tissue of older women, meaning that lumps are harder to notice.
 
‘Mammograms can be less effective for women under the age of 40 for this reason.’
 
Associate Professor Warrier sees GPs as central figures to the campaign, and to the process in general.
 
‘It’s got to start with the GP,’ he said. ‘GPs have always been the coalface for managing women’s health, and that shouldn’t change.
 
‘[The campaign is about] empowering women to have an idea of how to self-examine, and encourage patients who notice changes to have a clinical assessment with a GP.’
 
The self-examination process delineated by ‘Look, lift, feel’, is recommended to take about five minutes and be carried out every three months.
 
‘It’s important to spend time just being aware of what things look like, before touching,’ Associate Professor Warrier said.
 
‘So the idea is to “look” and then “lift” the arms up, focusing on the breasts, the nipples, and then areola.
 
‘When you lift the arms, you’re looking underneath the breasts as well, lifting the breasts with your contra-lateral arm when feeling.
 
‘And then “feeling” systematically, which can be done through three methods. One is a circular motion around the breasts; the other method is working down the breast which we call a vertical strip method, and the third is like a radial spoke where you start from the centre and work out, around the breast.’
 
Associate Professor Warrier wants the campaign to encourage women to become more attuned to their bodies, and aware of changes worthy of concern.
 
‘One aim is to increase awareness around [breast cancer], but to reduce anxiety, as well, in that by just being more aware of your body, you’ll be aware of what’s normal,’ he said.
 
‘But, importantly, it’s to pick up patients that would tend to dismiss changes within the breasts, while reiterating that the majority of those are benign changes, but promoting that if they notice something that doesn’t feel right, to present to their GP.’

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Women tend to put themselves second to the family at the expense of their health. Societal stigma plays a role in developing countries like Pakistan. The fair sex hesitate to speak openly about health concerns regarding their own anatomy, a recent story by BBC highlighted. 

For these women and others, being educated on the self-examination techniques of their own breasts could empower them. Although self-examination cannot provide the medical accuracy of a mammogram, it does help in the early detection of major lumps and abnormalities that appear on the breasts. 

Thoroughly examining one’s breasts needs no medical expertise, and can be performed in the privacy of one’s home environment. A few days after the period cycle ends is the opportune time to perform the self-examination since hormonal changes alter the breasts mid-cycle.

What better time to start than in the month of October, marked as breast cancer awareness month. Here are the five steps to follow. 

Step 1 – Place your arms at your side, near the hips, and stand topless in front of a mirror then begin noticing if there are changes in your breast. You need to check for changes in breast size, shape and symmetry. You should also be looking for dimpling and puckering of the breast skin. At first glance, inverted nipples and redness are also easy to spot. So, watch out. 

Step 2 – Lift up your arms and examine the breasts to identify these same issues. 

Step 3 – Next, look for any discharge from the nipples, either from one or both. They could be yellow fluid, watery and even milky. Be alert to anything dripping out of the nipples.  

Step 4 – Lie down and use the opposite hand to check each breast: left hand for right breast, right hand for left breast Instead of using the tips of your fingers, join the fingers and use the finger padding below in a flattened position. 

Rotate these fingers in small concentric circles, covering the whole breast including the nipple. The pattern can follow the increasing width of the circles formed with the fingers, until the entire breast has been studied. Also, pinch the nipples gently. 

Step 5 – Repeat the same movements with the fingers while sitting or standing upright. If it makes it easier to do this when taking a bath, when the skin is wettened, the same self-examination can be completed in the shower. 

This is not enough. For all women above 20 years of age, doctors advise going in for an annual breast exam. Younger women with a family history of breast cancer and associated risk factors should consider doing a mammography in consultation with their physician. All women above the age of 40 should have routine annual breast examinations. 

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