Lung Cancer JournalismCancer Journalism & News

If you’re a woman or a spouse or loved one of a woman — and that likely covers most people we know — you may be struggling with how to interpret some new guidelines on breast cancer screenings that were issued today by the U.S. Preventive Services Task Force. You’re probably very surprised to read their recommendations to push back initial mammograms to age 50 and conduct follow-ups every two years.

Thanks to the efforts of the American Cancer Society, Komen for the Cure, Avon, many other advocacy groups and even M. D. Anderson’s own Public Education Office, it’s likely that most women and their physicians would answer “40 years old” to the question: At what age should you get your first mammogram? Furthermore, we’d expect to hear “every year” in response to the question of how often to have this test.

Based on practices in our Cancer Prevention Center and the risk-based guidelines for breast cancer screenings, M. D. Anderson is standing by those recommendations.

If you’re of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren’t sure how to assess your risk, we recommend setting up time with your physician.

“We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40,” says Therese Bevers, M.D., professor and director of M. D. Anderson’s Cancer Prevention Center.

M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation.

Ongoing dialog and research on this topic are very important in the lives of many women. We’ll assess these findings and others in the annual evaluation of our guidelines in March 2010.

The task force, and M. D. Anderson, are united in our emphasis on developing risk-based,  specific breast cancer screening guidelines. We’ll continue to seek evidence that benefits women by catching this disease in its earliest stages.

“Doctors need to have more discussion about the risks and limitations of breast cancer screening with patients so they can participate in decision-making,” Bevers says. “There have been huge successes in teaching American women about the benefits of screening mammography, but women have not been educated about the limitations of screening — which is why many women believe that there is no harm in screening and if one test is good, two tests are better and more frequent testing with both is the best.”

Transcript from Houston Chronicle MedBlog Live Chat Event

In addition to her titles of vice president for nursing, chief nursing officer and chair of M. D. Anderson’s new Department of Nursing, Barbara Summers, Ph.D., R.N., is now a Fellow in the prestigious American Academy of Nursing.

One of only two AAN fellows at M. D. Anderson and one of 1,500 nationally, Summers was inducted into the prestigious organization during a formal ceremony over the weekend in Atlanta. She was one of 97 new inductees into the academy, an organization that monitors and advances health care policy and develops solutions to challenges facing the nursing profession. Selection as a Fellow in AAN is considered nursing’s highest honor.

Despite Summers’ stellar career as a nurse executive, teacher, mentor, administrator, advocate and researcher, she says she thinks of herself primarily as an oncology nurse.

“Oncology nurses are the secret weapons in the war we are winning against cancer,” Summers says. “They’re the critical thinkers, the caring partners and the constants in every patient’s personal journey, and it is my privilege every day to lead and work on their behalf — and to be one of them.”

Summers, who is from a family of nurses, is driven by not only her respect and love for nursing but the desire to build a culture that gives to all M. D. Anderson nurses the same inspiration, joy and reward that she reaped as an oncology nurse early in her career.

“Down deep with all of my leadership, advocacy and management experience, I’m still an oncology nurse at heart,” she says. “To this day, I remember caring for a little boy who received a bone marrow transplant and the relationship I built with his family. It’s an incredibly proud calling to be an oncology nurse, especially at M. D. Anderson.”

Summers came to M. D. Anderson in 1997 as clinical administrative director of the hematology clinical program, one the institution’s largest services. Leading up to her current position, she also has worked as associate vice president for clinical programs and vice president for outpatient services at M. D. Anderson.

Prior to coming to Houston, Summers was with the National Institutes of Health where she was manager of critical care. She has worked as a clinical nurse at hospitals in Virginia, Washington, D.C., and Maryland.

She earned her Ph.D. in health care administration, master’s degree in oncology nursing and bachelor’s degree in nursing from George Mason University. She has held faculty appointments at her alma mater as well as at Georgetown University and Catholic University.

One of Summers’ goals at M. D. Anderson and as a recognized national advocate for the nursing profession is to continue to drive home the messages that nurses are invaluable resources to their health communities and that nursing has changed for the better in the last decade. Every day, Summers and her team strive “to build a community of exceptional nurses engaged in extraordinary practice,” a theme that captures the essence of her goals for the department.

M. D. Anderson recently updated its cancer screening recommendations. While the new guidelines focus on a person’s chances of developing cancer, they also reveal when screening may no longer necessary.

What’s great about screening exams are that they have the potential to find cancer at its earliest stage, when the disease is most likely to be cured. For most of us, the benefits of getting a cancer screening exam outweigh the risks. However, there are some who may not benefit from having these tests. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains more.

Visit our website to review our cancer screening guidelines. To make an appointment in the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings simply fill out our patient self referral form.

Do you get tests to check for cancer, such as a mammogram or colonoscopy? What do you think about cancer screening?

By Deborah Thomas, Staff Writer

The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.

Deborah Scott, of the Native American Health Care Coalition, says, “In the native community breast cancer is a big problem, because many women are diagnosed late.” According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American
Indian/Alaska Native women have the lowest incidence of breast
cancer yet have the poorest five-year survival rates.

Event Sponsors:
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition
M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of… Wellness

Phase I clinical trials of patients with advanced cancers indicate that testing their tumors for a cancer-promoting genetic mutation is feasible in clinical practice and could be used to guide treatment.

Early results also show promising signs of an improved response rate among patients treated with drugs that inhibit the molecular pathway that is switched on by a mutation in the PI3CA gene.

Filip Janku, M.D., a fellow in M. D. Anderson’s Department of Investigational Cancer Therapeutics, presented new findings on the PI3CA gene this week at the a major conference in Boston – the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

Mutations in the gene turn on the PI3K-AKT-mTOR pathway, which is often abnormally activated in cancer cells.

Of 117 tumors tested from people with various late-stage cancers, 14 had the mutation and 10 of those were treated with PI3K-AKT-mTOR inhibitors based on that genetic analysis. Four of those 10 had partial responses, a high rate for a Phase I clinical, yet Janku notes the trial numbers are too small to draw conclusions now.

“These results need to be confirmed in a larger number of patients,” Janku says. “We will have that opportunity as we continue to offer PI3K screening to patients considering a phase I clinic trial.”  So far, responses were observed in patients with endometrial cancer, ovarian cancer, and breast cancer.

The American Association for Cancer Research highlighted Janku’s presentation in its news media program. The meeting is a combined effort of the AACR, the National Cancer Institute, and the European Organisation for Research and Treatment of Cancer.

Reprogramming Genes as Cancer Therapy

Jean-Pierre Issa, M.D., professor in the Department of Leukemia, and a leader in the field of epigenetics, discusses this very different approach to cancer therapy in a podcast from the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

“Cancer is as much an epigenetic disease as it is a genetic disease,” Issa notes. Epigenetic factors cause changes of gene expression and cellular behavior in cancer that are quite apart from those caused by genetic mutations or damage.

Issa studies these chemical influences on genes at the basic science level and has successfully translated his findings into the clinic. The podcast addresses the challenge of translational research as well as the case for epigenetic therapy.

Resources:

Read the News Release from AACR

November 18 Teleconferences and Podcast Recordings

Last week we talked about the importance of learning to take care of yourself in the midst of your expanded caregiver role.

I asked you to take care of your body, with exercise and good food, feed your mind by controlling stress and negative thinking, and feed your soul through mediation and prayer.

Below are the next three steps you can take, starting today, that will make a difference for you.

4. Self-Care: Preserving Your Energy

“My whole life has changed. I have no time for myself.”

When possible, learn to unplug yourself from your patient and replug into something that will energize you and bring a greater sense of peace and pleasure. It’s important to get away from cancer to recharge your battery so that you can come back refreshed and fortified to tend to your patient. Sometimes, just carving out 10 minutes for yourself can help rejuvenate and restore.

You have a very hard job. You likely are doing everything you reasonably can to take care of your loved one. Begin to learn to run on “premium caregiver fuel” by feeding your mind, your body and your soul with thoughts and activities that build, nurture, comfort and strengthen. This will conserve your energy over the long run.

Be good to yourself. You have the right and the responsibility to take care of yourself. This is not selfish, it’s self-care. Taking short breaks now will give you the energy and strength to stay in this for the long haul.

This is exceedingly important, but difficult for caregivers to give themselves permission to do. Many caregivers may feel guilty when they leave the patient’s bedside, when medically appropriate, to go do something pleasurable for themselves. However, research studies show that caregiver self-care is medically necessary for you to stay mentally and physically healthy and strong.

5. Self-Care: Evaluating Your Priorities

“I started to become realistic. I didn’t cause this cancer.
I can’t cure it or control it.”

Becoming realistic can be a mind-altering experience. Starting from there, consider letting go of the idea that you are Superman or Superwoman.

•     Practice being clear in your mind about what your job really is. Are you over-functioning for your patient? Are you doing things that your loved one is capable of doing for himself/herself? This is not unusual, especially in the beginning. Be clear in your own mind what’s really happening right now, not what “might” happen. Set reasonable limits with your loved one. Determine what self-care tasks he/she can do. A gentle reminder may be: Don’t do for your patient what he/she is capable of doing for himself/herself.

•     Take stock of the things that are really important that “must” be done, not what “should” be done. As one caregiver said: “I made a list of the things that I absolutely had to do, like organize medications, schedule appointments, etc. I made another list of things that I was doing that just didn’t really matter in the big picture. I just let those things slide off my back.”

•     If possible, delegate some responsibilities. Recruit others to help you.

•     Learn some practical problem-solving techniques, such as how to manage medication side effects, organize a medication sheet, and develop strategies for symptom control of pain, nausea or fatigue.

6. Self-Care: Finding Your Strengths

“I’ve been able to do things that I never in a million years thought I could do.”

•     Identify your strengths. Some caregivers have a hard time doing this. Your personality is unique and you bring talents and gifts to this demanding role of caregiving. What is it that you bring to the table that strengthens this situation that no one else can, or is willing, to do? What have you learned through this experience?

Other caregivers have identified their strengths and you can, too. Focus on what you’re good at doing.