Osteoporosis and Breast Cancer

Osteoporosis literally means porous bones. The result is that the bones can become thin or snap. Osteoporosis cannot be cured and often is not found until after bones break. It affects half of women over 50 and one in five men in that age range and some people who receive treatment for breast cancer are at an increased risk of ostoeporosis, however, treatments are available to try to keep bones strong and less likely to break.

Women who have not gone through the menopause before they are treated for breast cancer have an increased risk of osteoporosis. Indeed, chemotherapy can cause an early menopause and a rapid, significant reduction in bone density and result in osteoporosis.Even women who have been through the menopause may be at increased risk of osteoporosis because of the hormone therapies they take for breast cancer.

balanced her 2.jpgI am being treated with letrozole for my breast cancer. My tumour was of the fast growing HER2 positive variety. The letrozole is one of the drugs that reduces the amount of oestrogen circulating in my body and this could result in osteoporosis. I have my bone density checked with a bone density scan and, so far, I do not show signs of osteoporosis. Generally speaking, people with a good bone density before getting treatment for breast cancer are less likely to develop osteoporosis while taking an aromatase inhibitor such as letrozole.

I have been careful to put some simple lifestyle choices to help keep my bones strong and healthy. I ensure that, although I am vegetarian, I have a well-balanced diet. Although dietbalanced-diet changes will not cure bone defects, it may stop them osteoporosis getting worse. Eating meals that incorporate a wide variety of foods including fruit and vegetables, carbohydrates, milk and dairy products and proteins help achieve this. As a general rule it is recommended that we eat at least five portions of fruit and vegetables a day. You would be amazed how many people, including vegetarians, do not manage this! I have also significantly reduced my alcohol intake and the amount of fizzy drinks I take.

Calcium is a vital mineral for teeth and bones. It gives them strength and rigidity. Most of the calcium found in our bodies is in our bones. Dairy produce is our main source of calcium. People  can usually get enough calium through a healthy diet that includes dairy products. If your diet did not include dairy produce you would need to ensure you got calium from another source such as a calcium supplement.

I also have to bear in mind that vitamin D is needed to help my body absorb calcium. The best source of vitamin D is sunlight. Human bodies use the sunshine to make vitamin D in the skin. The vitamin D is fat-soluble and the body stores it for use in the winter months. balanced sunWe only need to be out in the sun for about quarter of an hour a day during the summer months to give most people enough vitamin D for the whole year. So a walk, some gardening or a round of golf should make sure we get enough vitamin D. In addition to that, margarine, egg yolks and oily fish also contain vitamin D.

Regular weight-bearing exercise is also important to put force through the bones. This helps stimulate growth and strength and keep bones strong and healthy. Such exercise includes skipping, aerobics, tennis, and dancing are good bone building activities, even a brisk walk can be of benefit to bones. I try to do some exercise at least three times a week in order to combat the cancer-related fatigue I suffer and the potential for weight gain that my medication induces. I really try very hard to make sure that I do not add osteoporosis to my list of worries.

Valerie Penny

 

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Radiotherapy after Breast Cancer

My Uncle suffered from colon cancer and had told me that radiotherapy was not nearly as difficult to bear as chemotherapy. However, when I came to receive radiotherapy for my breast cancer, I came to disagree with him. Radiotherapy treatment is planned and delivered by specially trained professionals called therapy radiographers. It is given by a machine called a linear accererator. Breast cancer patients are usually treated for between 3 to 6 weeks.

The treatment only lasts a few seconds, but to get prepared and settled on the machinery, the period each patient is in the room is about 10 minutes. I needed four weeks treatment. It is given on week days, every week day except for public holidays, for the stated period, so I had to go for treatment 5 days a week for four weeks.

The treatment, at least at first, is painless. Still, reasons that I did not agree with my uncle were that the journey to the hospital that delivers the treatment is an hour’s drive from where I live, and an hour’s drive back. Given that and the wait for treatment at the beatsonhospital could mean a 3-4 four round trip. That was terribly tiring. Also, the treat ment is given in a large room that contains nothing but a chair to place my cloths on, a screen for the radiographers to stand behind as they deliver treatment and the machine, itself.

Patients are not treated by the same radiographers each day and students, male or female, may be amongst the team. I should have been asked if I was willing to have a student present , but I never was. Like many who suffer from breast cancer, I come from a generation that is not used to displaying my body to other people, especially much younger men. I was simply told to take off the clothes on my top half and come over to the machine. It was embarrassing and demeaning. I was just given a piece of paper towel to cover my modesty. Needless to say, that did not work!

The way this treatment was delivered was embarrassing and demeaning. The journey to get the treatment was long and tiring. During treatment I had to lie in a specific position so that the radiotherapy could be delivered most accurately. The radiographers dimmed the lights for a short time while they positioned the machine. They then stood behind the b machinescreen while the treatment was delivered.Once or twice the treament given was slightly different in that it was a boost to my scar area. However, the method of delivery and the lack of attention to personal sensitivities was the same as ever.

The treatment results in a cumulative effect to the cancer and side effects. At first, I felt no different after treatment. It was only after two weeks or so that I bagan to feel side effects and so terribly tired, weary, as a result of the treatment. It also caused burning on and in the flesh around my breast. The hospital provded aqueous cream to soothe that.

I needed the radiotherapy to help beat the cancer, but it was difficult to bear.

Valerie Penny

FEC Chemotherapy for Breast Cancer

When I was diagnosed with breast cancer, apart from being completely taken aback that something like this could happen to me, I got detailed advice from the oncologist about the type of treatment I would need.

fecI was told that after surgery to remove the tumours, the oncologist told me that I would receive chemotherapy and then  radiotherapy. The chemotherapy I received was called FEC. This is a combination of three chemotherapy drugs 5 fluorouracil, epirubican and cyclophosphamide. FEC takes its name from the initial of these three drugs.It is normally used to treat people with primary breast cancer that has not spread to other parts of the body. Chemotherapy destroys cancer cells by interfering with their ability to divide and grow.

All cells in our bodies continually divide and grow. This enables growth and repair of body tissue. Cancer cells are different because they grow by dividing in a disorderly and uncontrolled way. Different chemotherapy drugs work in different ways and attack the cancer cells at different stages of their growth. This is why a combination of drugs is often more effective than just one drug.

I was given my FEC intravenously. I had a Hickman line fitted because the veins in my hands did not allow easy acces for the cancer nurses.  All my medication was given through my Hickman line. I did not like having it, but it was useful. I was given the FEC as an out patient, every three weeks for 18 weeks. This meant I could go home on the same day after treatment, that was nice, but the days were long and tiring. The time involved is not just that required to give the drugs, but also waiting time, blood tests and time for the drugs to be prepared.fec tired

I suffered side effects with FEC. The common side effects include bone marrow suppression.Bone marrow suppression or myelotoxicity is the decrease in production of cells responsible for providing immunity, carrying oxygen and those responsible for normal blood clotting. Bone marrow suppression is a serious side effect of chemotherapy. The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream. However, the drugs affect new blood cells that are being made by the bone marrow. The suppression of bone marrow activity causes a deficiency of blood cells. This condition can rapidly lead to life-threatening infection, as the body cannot respond to invading bacteria and viruses.It can also leading to anaemia due to a lack of red blood cells and spontaneous severe bleeding due to deficiency of platelets. This resulted in me suffering from severe tiredness and exhaustion. It is difficult to describe the depth of the feelings of exhaustion. I also had several spontaneous nose bleeds.

Other side effects include nausea and vomiting. The hospital supplied medication to minimise this. I was instructed to take the medication at specified times after my treatment. However, the most visual side effect of chemotherapy is hair loss. I did try an ice-cap to reduce that, but to no avail. It did not work.

fec baldWhen people think of hair loss, they, and women in particular think of the loss of hair on their head. Certainly that does go. The result is a cold head in winter! However, all of the hair on my body was lost. This included the hair on my limbs and inside my nose. The good news was that I did not need to shave my legs for a year, the bad news is that it meant there were no hairs to stop my nose from running. Always carry a handkerchief!

I was not going to bother buying a wig. However, my cancer nurse advised that I should. This was partly because it might make the sight of me during my illness less difficult for my children and my elderly mother. She also pointed out that it would keep my head warmer, especially in winter. She was right on both counts.

Cancer affects not just the person who is diagnosed, but all the people who love them: their friends and family. I hope you never suffer such a diagnosis, but if you do, bear in mind the agony of those around you.

Valerie Penny

 

Information about Taxotere (Docetaxel)and Breast Cancer

During my treatment for breast cancer, one of the drugs that I was treated with was Taxotere. It is also known as Docetaxel. It was used for me to treat primary breast cancer that had not spread to other parts of the body. It was used in combination with other drugs in combined chemotherapy. Docetaxel is also sometimes used to treat breast cancer that has come back after treatment or spread, for example, into the lymph nodes.

It works by interfering with the development and growth of cancer cells. Docetaxel blockshickman line.jpg part of the cancer cells before they divide and grow. This makes the cancer cells die off at an early stage.

When I was given Docetaxel, it was gven to me intravenously through my hickman line. I had three weeks between each round of chemotherapy. So, just about the time I was feeling normal again, another dose of the drugs was given.

Docetaxel has side effects. All drugs have side effects. Some people are more suseptible to them than others.Amongst the common side effects of Docetaxel are: bone marrow suppression, hair loss and nausea.

The bone marrow supression was the side effect that worried me most, because this means that I had an increased risk of getting infections when my white blood cell count was low. As a result of this, I was unable to go out and mingle with friends or relatives after my treatment. It made me feel isolated and lonely. My resistance was lowest around 5-10 days after I had had my dose of Docetaxel. So for about one week in every three, I had to be particularly careful to avoid infection. I was warned that, if I did feel unwell during this time, or if my temperature ever did go up over 38C then I was to get medical help or go to the hospital.

I managed to avoid having to go into hospital, but I did find that I bruised more easily and had nose bleeds that were difficult to stop and did suffer from anemia.I did not need any blood transfusions, but I did take iron tablets to boost my red blood cells.

Nausea was a problem for me, however, I was given medication to control this. The anti-sickness tablets were very effective and I was grateful for that. I also noticed that the taste of many foods changed while I was on chemotherapy. Much tasted like tin. However, I am glad to say that my sense of taste has returned to normal since my chemotherapy cancer-101-s8-tnm-stagingtreatment has finished. I was told that I might suffer from diarrhoea, however, my body reacted differently and I suffered more from constipation than diarrhoea.

The other side effects I suffered when being treated with Docetaxel tiredness, fatigue and pain in my muscles and joints. I still suffer from these over a year after termination of my treatment. When the pain is severe, I take pain relief or anti-inflammatories, but I try to avoid them as far as possible. Common practice says that gentle exercise improves the fatigue. I find it merely replaces it with exhaustion!

All in all I found chemotherapy difficult, but it is miles better than the alternative: no treatment: no recovery.

Valerie Penny

Dealing with Cancer in the Workplace by guest author Ryan McChrystal

This article, Dealing with Cancer in the Workplace by Ryan McChrystal first appeared on Tuesday, 10 March 2015 in http://elitebusinessmagazine.co.uk/people/item/dealing-with-cancer-in-the-workplace

Serious illness – particularly cancer – can have a devastating impact on your employees and your business, therefore it is essential to have a plan in place that ensures the best way forward for all concerned

Dealing with cancer in the workplace

Cancer isn’t an easy thing to discuss. There is no shame in admitting that. However, with around 750,000 people of working age with some form of it in the UK – representing over a third of the 2 million people living with the condition – it is wise to think about your approach now before you, as an employer, have to deal with it. With people living longer and retiring later, the numbers of people in the workplace diagnosed are only going to increase. Cancer is just one – and certainly the most emotive – example of the serious illnesses that could impact on your employees, their attendance and productivity.

“The pressures put on an employee with cancer have a direct effect on their ability to manage or even recover,” says Elliott Hurst, director of health consulting at AXA PPP Healthcare, one of the biggest UK health insurance providers. The physical and emotional strain of a serious illness can be severe and, when you combine that with the potentially damaging financial impact, the result can be devastating. But that’s not to say a diagnosis automatically leads on to periods of absence.

“From an employer’s perspective, it is better to have your experienced and valued employees contributing to the workplace in some way, shape or form than not and with proper planning this can be achieved,” says Hurst. Therefore, an effective workplace policy should be in place to ensure you are best equipped to deal with cancer and other serious illnesses. As with all good policies, it is best to begin by amassing all the relevant information that’s available, including a full understanding of the law. As an employer, you are legally obliged to make workplace adjustments where appropriate, just as you would with any other disability. Access to Work is a specialist disability service delivered by Jobcentre Plus, which gives practical advice and support that may be able to help with the cost of making workplace adjustments.

“It is good to have a better understanding of the illness your employee is suffering from. Cancer, for example, is not a single disease with a single cause and a single type of treatment,” says Hurst. “Each cancer experience is different, but having a little knowledge can help you as an employer to better understand what the person is going through and how best to support them.”

A government white paper in 2011 suggested that employers need to do more about the health of their employees. Dr Gordon Wishart, a cancer surgeon and medical officer at HealthScreen UK has seen a major rise of employers offering cancer screening as part of their benefits packages. “Companies are engaging with us to explore early cancer detection for their employees, which in many ways is adding to the already existing employee benefits that are available through employers and in some cases that’s been completely sponsored by the company,” he says.

With most cancers, if you pick it up early it requires less treatment, which is a better outcome for employees and for the employers. “It means less time off work, and getting that employee back to their desk as soon as possible and back to being an efficient, productive member of the team,” says Dr Wishart. A screening by HealthScreen UK only costs around £100 and if it is paid for through a salary sacrifice, it becomes more tax efficient and an employee will only pay around £50-60, or about £5 per month.

Often a small business won’t think about the issue of cancer until it is raised by an employee, which can take managers and HR by surprise. Therefore they are often nervous and uncertain about what to say. Good quality conversations between employee and employer are essential to understand their requirements and plan for the best possible support.

“It is important for employers and managers have some kind of training or insight that allows them to understand how much a serious illness like cancer can really turn somebody’s life upside down,” says Dr Jill Miller, a research advisor at CIPD. “Have an awareness of the emotional and financial strain it puts on people and that how you respond and support employees has a huge impact on both their morale and on the rest of the workforce as they will see the organisation is a good place to work.”

There are a few things to bear in mind when having these conversations. “It is best for the manager, the employee and HR to get the expectations out at the beginning,” says Dr Miller. “It is important to talk about who the employee wants to know among the business and how they want other people to react. Do they want people to talk about it, or do they want them to act normal and talk to them as they always have done?”

Needs will differ from employee to employee and from cancer to cancer. Different cancers will have different paths and treatments will have different demands on people, so constant conversations with employees to get updates on their progress is essential to know what’s going on. “It’s important to think about what support and flexibility you can offer to help people stay in work,” advises Dr Miller.

Employers also need to understand that recovery is a process and that it takes time. Legally, they have a duty to make reasonable adjustments to support a return to work, which will depend on the circumstances, including practicality, cost and the extent to which an adjustment will be effective in alleviating any disability. Adjustments might include offering lighter duties or allowing extra breaks.

These days, many people are cured of cancer or are able to live with it for many years. Some people may have short or long-term side effects from the illness or its treatment. Therefore, they may continue to need support after their treatment ends. “Many people tell us that that work can help to restore a sense of ‘normality’ after a cancer diagnosis. Try to find out a little about the type of cancer your employee or the person they are caring for has and what the effects of treatment are likely to be,” recommends Hurst.

Work contributes to financial independence, provides a sense of purpose, creates structure in our lives and is a lifeline back to normality, wellbeing and recovery for those suffering. For Dr Miller, it is essential to make the transition back to work as easy as possible. “It is also important to think about employees caring for those with serious illnesses and how to respond to employees who are supporting a family member or close friend who has had a cancer diagnosis.”

There is comprehensive legislation in place to support a successful return to work. Together, the Equality Act 2010 and the Disability Discrimination Act 1995 provide protection from discrimination. Everyone with cancer is classed as disabled from the point of diagnosis for the rest of their life, and their employer or a prospective employer must not treat them less favourably for any reason relating to their cancer. All areas of employment are covered including recruitment, promotion, training, pay and benefits.

Coming back to work can be very difficult for a patient. A recent study by Macmillan, the cancer charity, showed that 57% of survivors who were in work when diagnosed had to give up their job or change roles due to their illness. This means the total loss in productivity of survivors unable to return to paid work in England was estimated, in 2008, to be as high as £5.3bn. You must be prepared for such a possibility because small businesses often rely on teams that, while few in number, are high in skills and experience, so the impact can be particularly devastating.

If an employee comes back to work, which is often the case, there are a number of steps that can be taking to make things easier. This includes implementing a standard, phased return to work plan. You should also provide regular catch-ups to check all is working well.

More than anything, a clear policy is key to coping with cancer in the workplace. But it’s important to remember that with the devastating effects of serious illness on employees, there are no quick fixes.

Ryan McChrystal

How Cancer Will Affect Your Business by guest author Professor Gordon Wishart

gordon wishartProfessor Gordon C Wishart MB ChB MA MD FRCS FRCS FRCS is a graduate of The University of Edinburgh, Scotland and consultant breast & endocrine surgeon at Addenbrooke’s Hospital, Cambridge, England.

It is calculated that, currently, one in three people in the UK will get cancer of one type in their lifetime. Cancer charity Macmillan estimate this will rise to one in two by the year 2020.

New methods used by Cancer Research UK to calculate these figures, however, suggest that the 50 percent level of cancer incidence may already be upon us. A recent survey conducted by Cancer Research UK also revealed that cancer is now the UKs number one fear, ahead of being in debt, old age, being the victim of knife crime, car accidents, having a heart attack or losing a job or home.

This, of course, is not good news for anyone – but some employers may still be wondering what this has to do with them. The fact is, whether employers choose to take action or not, cancer is going to have a serious impact on them, their workforce, and their business. The NHS has identified that around 13,000 men and women die every year from work-related cancer – but the impact is not limited to areas of work that specifically put workers at higher risk. Of the 325,000 people diagnosed with cancer each year, over 100,000 are of working age, and estimates suggest that over 750,000 people of working age are now living with a diagnosis.

Alongside this, we need to consider the friends, spouses and families of employees. One does not have to be personally diagnosed with cancer to be hit by its effects; having to care for a loved one under these trying circumstances – not to mention the psychological impact of a cancer diagnosis – can also mean increased downtime among employees who are otherwise healthy.

Little wonder then that the Department of Health is asking employers for help to fight the massive cancer burden. On the positive side, there is a lot that employers can achieve, if they choose to act. The key is cancer screening and awareness in the workplace.

About Check4Cancercancer microscope

Check4Cancer Ltd. (previously known as International HealthScreen Technologies Ltd) started its existence in Cambridge in 2006 when the two founders Prof Gordon Wishart and Troels Jordansen met. The first BreastHealth UK clinic started at Spire Cambridge Lea in April 2008.

Today Check4Cancer offers 6 innovative different services for early detection of cancer. The services are:

BowelCheck BreastCheck GynaeCheck
LungCheck ProstateCheck SkinCheck

Above 6 services cover 90% of all new cancer incidence in the UK every year.

The services are supervised by a Board of Clinical Advisors; please click here for more details. All advisors are nationally renown  experts within each cancer area.

Throughout a network of over 80 clinics across the United Kingdom private individuals and companies can access these services. 2 of the life saving services (BowelCheck and GynaeCheck) requires no clinic but are based on home sampling.

Besides services for early detection of cancer Check4Cancer also operates the largest independent network of genetic counsellors and test. GeneHealth UK offers several cancer genetic tests ranging from gold standard BRCA 1&2 tests to innovative cancer panels. Pre-conception testing is being introduced during 2015.

Breast_Cancer_1With around 1 out of 2 Britons getting cancer over their lifetime cancer is a very serious issue for individuals and companies. On this background Check4Cancer is proud to be working with some of the leading companies to offer affordable services for early detection of cancer and cancer awareness services. Please click here for a list of such companies.

Check4Cancer is working according to ISO9000 and ISO270000, regulated by CQC, complies with the requirements of the Cyber Essential Scheme, registered with ICO is very proud to have 93% of our clients rating us ‘Very Good’ to ‘Excellent’.

Gordon Wishart

Risk of Recurrence of Breast Cancer

herceptin_drugMy body has endured surgery, chemotherapy and radiotherapy. As a result of this I have lost my hair and my energy. Still, that tumour the size of a baked bean is perceived as a threat. Its return must be further discouraged. My oncologist therefore insists on mammograms every six months and prescribes Letrozole. I must take one 2.5mg tablet each day for 5 years.

Breast cancer is often discussed as a general condition, but there are several different types that require different treatments. One way to distinguish breast cancer cells is through your genes. When you are diagnosed with breast cancer, your doctor will test the cancerous cells to determine their genetic makeup. My tumour had more of the HER2 protein in it than it should have had. HER2 is a protein that stimulates the growth of breast cancer cells. It can be found in your blood and urine. Sometimes it is referred to as a tumour marker. Tumor markers like HER2 cannot be used for cancer diagnosis, but they can provide other important information and the presence of HER2 helps the doctor predict how likely the breast cancer is to respond to treatment.

It is estimated that about 20 percent of breast cancers are HER2-positive. Younger women are more likely to be her_2_geneHER2-positive than older women. HER2-positive breast cancer tends to be more aggressive and to spread more quickly than other cancers. That is why it is important to find out if the cancer cells in your body contain this protein. If your breast cancer is HER2-positive, you have a much better chance of successful treatment with methods that target the HER2 protein specifically. Results show that those who tested positive for HER2 at an early stage of the condition (with tumours 1 centimeter or smaller) had a higher risk of recurrence. Researchers have also found that HER2-positive patients had a 77.1 percent five-year survival rate, with no recurrence. However, they also are
around five times more likely to suffer recurrence than those who were HER-2 negative and have close to three times the risk of recurrence of those who tested negative for HER2. So I am absolutely sure I want to discourage recurrence.

Tumours that are HER2-positive are more often associated with factors that increase recurrence rates. For example, HER2 tumours are more likely to occur in younger women and have higher nuclear grade. Generally, the higher the nuclear grade, the more aggressive the tumour. HER2 tumours are also more likely to show positive margins during breast surgery. Positive margins occur when cancer cells extend beyond the edge of tissue that is removed. HER2 tumours also have a higher likelihood of residual disease being found when additional tissue is removed. Up to 70 percent of patients with HER2-positive breast cancer respond to treatment. However, total remission for the condition occurs only in around 7 to 8 percent of patients. Targeted treatments (medicines that target the HER2 protein, like the Herceptin I was treated with) have improved the prognosis for HER2-positive patients. Remissions can also be lengthy, offering another bright spot in prognosis and reports show that remission can last more than 15 years for some patients.

tabletI was diagnosed HER2-positive and this brings special challenges in my recovery from breast cancer. The HER2 protein can make the breast cancer more aggressive. It can also make it harder to treat with hormone treatments used for other types of breast cancer. However, drugs like trastuzumab (Herceptin) target HER2 directly and effectively. This drug, when used in combination with other drugs, shows some very promising results for improving prognosis and survival rates for patients with HER2 cancer. However, there is a small but real risk of heart damage and possible lung damage. Scientists are still studying how long women should take Herceptin for the greatest benefit. I am not ashamed to tell you that I hope their studies are successfully concluded soonest. I have a vested interest in this, as my tumour was HER-2 positive.

All in all, having made the decision to stay alive long enough to thoroughly embarrass my children, when the oncologist tells me that I must take one 2.5mg tablet of Letrozole each day for the next five years, I will do just that. Letrozole has side effects but I have decided that whatever they are, they have to be better than allowing the tumour to return.

Valerie Penny

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