Genetic Testing and Non-High Risk

A person can be considered medically high risk due to their or a family member's medical history. If you are considered medically as high risk, you get popped into the category of give them lots more medical attention and 'lovely' tests.

Now with the progress of genomic testing, its no longer a big expensive, rare proposition. However, why do we only test the high risk people? These are the people who already know they are high risk. But that leaves a lot of people who don't know they are high risk and could be. This doesn't make sense. Some new research asks if it wouldn't it make more sense to test more people who aren't necessarily considered high risk? That might be more practical and save lives.

"A study published in the Journal of the National Cancer Institute indicates that screening the general population for mutations in specific genes is a more cost-effective way to detect people at risk and prevents more breast and ovarian cancers compared to only screening patients with a personal or family history of these diseases.

Current guidelines recommend that only those with a personal or family history that could indicate a greater risk of developing cancer be tested for gene mutations that can cause the disease. However, the successful use of testing for high-risk groups has led many to consider extending genetic testing for cancer to the whole population."

As I said it does make a lot of sense to do this. You would find people who did not know they were high risk and help prevent many more cases of breast and ovarian cancer. 

Mutations that cause cancer can occur in many people with no history to indicate a risk. These people are therefore not included in screening programs that target high-risk patients and the mutations remain undetected. The researchers of the new study estimate that implementing a program to test all women over the age of 30 could result in thousands fewer cases of ovarian and breast cancer in women in the US and UK.

However my response to this idea is a big fat 'No'. Isn't it kind of 'big brother-ish'? Yes it is. I'm sorry, but I would not approve of their approach to testing all women over the age of 30. The researchers then suggest:

"Population testing for breast and ovarian cancer gene mutations is the most cost-effective strategy which can prevent these cancers in high risk women and save lives,” said the paper's lead researcher, Ranjit Manchanda. "Our findings support broadening genetic testing for breast and ovarian cancer genes across the entire population beyond just the current criteria based clinical approach...""

It may be cost effective but that is not a way to treat patients. We are not little cost effective units that can be modernized or tested to meet some kind of cost effective study. We are human beings and need to be treated as such.

Yes I agree that we are normally subject to requirements to be immunized for certain illnesses. But this is different. Part of the reason for immunizations are that they are to prevent contagious diseases that can be passed from person to person. They can cause epidemics that can kill multiple people and cost significant amounts in medical bills.

Ailments causes by genetic mutations are not contagious. They affect only one person at a time. A person's genetic traits are unique. They should be kept private. They do not belong in some database anywhere to follow people around.

This would result in discrimination and bias if known to potential employers, health insurance companies, and life insurance companies. Even if such discrimination was illegal it would still happen. So no way in my opinion.

Finally, what if patients do not want to be tested. Some people (myself included) would not want to know the results of such testing. This is why I will not go to a fortune teller or tarot card reading. I do not want to know. I have enough to worry about as it is.

Clearly this is a case of 'just because we can, doesn't mean we should'.

Cancer Prevention (Or Why Me?)

I have a feeling I am bit cynical these days. This morning I found a post by Dana Farber's Insight blog on cancer prevention tips, which caught my cynical eye.

I was 19 when I was first diagnosed with cancer. Okay, I admit to smoking some by then but I wasn't much of a drinker until I got to college (!!). I was pretty active. I was young. Any bad habits didn't have much time to turn into a cancer, or so I think. 

Then by my second diagnosis, 26 years later, I might have had a few more bad habits but I was pretty active and got check ups, wore sun screen and in good shape. 

This is my family history of cancer: one grandfather got prostate cancer, the other one got gall bladder cancer, and one of my mother's cousins had breast cancer in the 1970s and is fine. (Considering my mother had forty something cousins, that's not a bad record.) 

So what happened? Why me? Why was I the one to be diagnosed with cancer? Twice? 

As for all my other ailments, my mother has had a bad back for years and also has rheumatoid arthritis. No one else has anything like I have. My father, in his late 80's, has been known to call me and ask questions about upcoming medical procedures because I have had way more than him. I ask again, why me? I am a bit cranky about this. Still. I mean why did I end up with this medical history? 

Do you see what I am saying? How did I end up with my medical history when I am surrounded by a family of healthy people? 

Its very frustrating when you follow the rules and still end up with all the medical crap. And I really don't understand what I can do to prevent more cancer - once you have a cancer diagnosis, your risk for future cancers greatly increases. Grrr.

Deflation

Here's another exciting new headline: Unlikely drug may block breast cancer in high-risk women. But then as you read it, you end up feeling deflated. Why? Because you find out at the end that it will take 10 years before the results of clinical trials will be available. And that it is based on a very small research pool. 

But here goes. So a drug, denosumab (or Prolia) used to to treat osteoporosis appears to prevent growth of breast cancer in high risk (read BRCA1+) women. This could be a prevention strategy for this group of women. This sounds like fantastic news. 

"For the study, 33 samples of breast tissue with no BRCA1 mutations and 24 samples of breast tissue with the mutations were analyzed."

So its a little tiny group. I am not sure that I am too impressed with the size of this group. And that the results were published based on such a small group. 

You would think that since the drug is approved already it would be fairly quick to be available for this use but since the clinical trials will take so long to see if cancer growth is prevented it will take ten years to get through trials and then FDA approval, and then finally available. 

As the article concludes it might be a solution for future generations. I am just a little deflated as I went from high expectations to a long wait.

Trying to scare or educate us?

I like these little articles found all over the internet: "signs of  [insert disease name here]". I just found one this morning for signs of oral cancer.

Oral cancer is not something that has crossed my mind really. A few years ago I had a pocket appear in the back corner of my mouth and the dentist (stupidly) said to me "Well it doesn't look like cancer but you really should have Dr F look at it to be sure." Note: never say that to someone with cancer.

But these are the signs of it so you should see your dentist regularly:

• A sore on the lips, gums, or inside of your mouth that bleeds easily and doesn't heal
  
• A lump or thickening in the cheek that you can feel with your tongue
• Loss of feeling or numbness in any part of your mouth
• White or red patches on the gums, tongue or inside of mouth
• Difficulty chewing or swallowing food
• Soreness or unexplained pain in your mouth, or feeling that something is caught in your throat with no known cause
• Swelling of the jaw causing dentures to fit poorly
• Change in voice

Now that I have this list, what should I do? Of course there are little lumps and bumps inside my mouth that I can feel with my tongue. I don't have dentures so that one is out.

Now that I have this list I can obsess over it for as long as I can remember it.... That's the biggest problem. We get a list of signs to look out for whatever the ailment is. We read it. We think about it. Then our brains are full and it falls out, or we convince ourselves we have it and rush off to the medical professional insisting that we are going to die!!!!

Scared or educated? I'm not sure.

Changing views on breast cancer

Treatment for breast cancer has changed over the past decades. This is a known fact but some of the newest changes are summarized in a recent article in the New York Times, "Outsmarting Breast Cancer". A couple of key points that hit home:

'“The size of the tumor and presence of positive nodes may not matter as much as we thought,” said Dr. Deborah M. Axelrod, a surgeon who directs breast cancer programs at the center. “It’s not even true that if the cancer is metastatic, it’s curtains.”'

While I do not have metastatic cancer, I have long thought that advances in treatment make cancer more of a chronic as opposed to a short life sentence.

'Instead of waiting for cancer to recur in certain high-risk patients, scientists are now developing techniques to outsmart the cancer cell’s aggressive tactics by prompting the patient’s immune system to launch a continuous attack that keeps the disease at bay indefinitely.

I like that one even better - preventing recurrence. Remember an ounce of prevention is worth a pound of cure.

Even lumpectomy could eventually become a thing of the past if these techniques achieve their early promise.'

I really like that. Three lumpectomies later, I am a little lumpy..

'...gone is the simplistic notion that cancer is a disease of abnormal cell division, said Dr. Larry Norton, deputy physician-in-chief for breast cancer programs at Memorial Sloan Kettering. “It’s a disease of abnormal relationships between the cancer cell and other cells in its environment.”'

The cells are hanging out in the bad neighborhood obviously. I had heard this a few years back when I heard Dr Susan Love speak. Bad friends lead to bad things - remember what your mother said about some of your friends?

So change for the good for once.

So what did I do wrong?

There is a new study out there saying that half of all breast cancers can be prevented. So what did I do wrong? That's what I feel. When I first read this I thought that its good news. But then I started thinking. What did I do wrong to get breast cancer before 50? Is it some how my fault?

I eat a good diet, I get exercise, blah, blah, blah. And there I end up with cancer. Twice. Maybe its my elementary school which is currently being turned down because its full of PCBs. Maybe because I stayed up late, smoked, and drank some. Who knows. But don't make it my fault.

But then I decided what I really don't like is the title of the article I first found: "Up To Half Of All Breast Cancers Are Preventable". That article was based on an article written in CA, A Cancer Journal for Clinicians where the original article is called "Priorities for the Primary Prevention of Breast Cancer" . Its all in the wording. Take the blame away from the patient please.

If you read the original article, it focuses on prevention options such as exercise, healthy weight, alcohol consumption, and more. Patients who drink alcohol, do not exercise, and/or maintain a healthy weight, have a greater risk of developing breast or other types of cancer. That's helpful.

Before breast cancer, I was thinner, exercised and I less to drink about, so go figure

Preventive Medicine or Too Much of a Good Thing

When do we draw the line for preventive medicine? The latest ASCO guidelines for high risk, post menopausal women to prevent breast cancer recommend proactively taking Evista, Aromasin, or Tamoxifen to reduce risk. I had already heard about Tamoxifen but not Evista or Aromasin.

When I first read this the first thing that jumped into my tiny chemo-fogged/fibro-fogged brain is this a big ploy by the pharmaceutical companies to generate millions of new patients? That would be a huge conspiracy theory that I immediately pushed away.

The next thing that leaped into my tiny chemo-fogged/fibro-fogged brain is that its getting to be that we need to stop enjoying ourselves and live preventatively with no fun? The guidelines end with:

"If you have a higher-than-average risk of breast cancer, it makes sense to do everything you can to keep your risk as low as it can be. There are lifestyle choices you can make, including:

• maintaining a healthy weight
• exercising regularly at the highest intensity possible
• limiting or avoiding alcohol
• limiting processed foods and foods high in sugar
• eating healthy, nutrient-dense food
• not smoking"

I felt this is getting to the point of  ridiculousness. I mean 'healthy, nutrient-dense food' - can you please define that? I am sure it does not include chocolate or ice cream. If I went to the grocery store and asked for 'healthy, nutrient-dense food', I think they would look at me like I was crazy.

And exercising regularly at the highest intensity possible? This is getting to be too much in my book. Just tell me to live healthy and I can handle that.

I am not dissing ASCO here. They are a wonderful organization but I think that this is overkill.

Yes preventive medicine is a good thing but this is too much. I'm sorry.

Colonoscopy Sweepstakes

Who would have thought that Ozzie Osbourne would become an advocate for colonoscopies? Well he has after one' saved his wife's, Sharon, life. He started a sweepstakes where the winner gets flown to New York and gets a free colonoscopy and three day stay in the city. Well if you have been putting off this potentially life saving procedure, I'm sorry but you are running out of excuses.  Dave Barry summed it up  in one of the funniest columns I have ever read - basically none of us want a camera up there. Go enter at CBS Cares - deadline is March 30.

Rock on Ozzie.

Exercise, Schmexercise

Go exercise they tell us. (Who are 'they' anyway?) We say we will but do we ever? Have you seen the commercial on TV about the couple who makes the lamest excuses not to go to the gym? I can't even remember what its for but I just remember some really lame excuses. I have used some myself - 'I don't feel like it', 'I have to clean the cat box', 'I went to the gym yesterday', and 'I need to catch up on my DVR watching'. If you want more, I'm happy to come up with them.

Truth be told, I used to go for a daily walk but I wasn't deflabbing properly so I joined a gym which I never went to because the machines were complicated and they made my back hurt. So then I joined a fancy gym with trainers and many dilapidated people like me. They gave me an exercise plan which accounts for my dilapidation. I have since learned that I can only go to the gym every other day. If I attempt to go two days in a row, my body revolts and I end up horizontal as I recover. My current solution is to go to the gym Monday, Wednesday, and Friday and go for a walk on one of the weekend days. I did not go yesterday. This means I need to go for a walk today even though its colder out today. Maybe I'll be whiney as I go for my walk.

Exercise is a good thing. It doesn't have to be as complicated or as expensive as going to the gym - you have two feet so use them.  I can go on and on about exercise at any time but here are some real facts from professional medical people who actually aren't making things up:


Research has shown that exercise can help:

• keep your body fat at a healthy percentage
• keep your weight at a healthy level
• lower your risk of many diseases, including breast cancer
• reduce the risk of breast cancer coming back if you’ve been diagnosed
• keep your bones strong and ward off osteoporosis
• improve your mood
• improve sleep quality

That little line about lowering your risk of cancer is a subtle hint. But I am proof you can get cancer even if you exercise. So all this tells us is 'they' (whoever they are) don't know crap. 

Breast cancer vaccine?

Here's a perky article telling us that the Dept of Defense has developed a vaccine to prevent breast cancer recurrence. It is just ending its stage II trials and will start stage III shortly. If successful through this phase, then they can apply for FDA approval - in five years. That really isn't that far away and they are currently recruiting participants.

With out getting technical, which I am not really capable anyway, the vaccine relates to the Her2 status of breast cancer and works with the body's immune system to reduce recurrence rates. In trials, it reduced expected recurrence rates by 50%.

Most breast cancers, like mine, are Her2 negative. So, if it is using the Her2 protein and I have a negative status, will it work for me? I am confused. I need a translator here.

"The vaccine, Peoples explained, targets a protein commonly over-expressed in breast cancer cells called human epidermal growth factor receptor 2, or HER2/neu.

Cancer vaccines typically target some protein or antigen expressed on cancer cells, he noted. “The idea is to train the immune system to recognize that protein or piece of protein that’s highly expressed on cancer cells, but not on normal cells,” he said. “That way the immune system can differentiate what’s abnormal and normal. If the immune system can recognize it, it marks it for death, basically.”"


"The researchers targeted the HER2/neu protein, which is expressed at varying levels in women with breast cancer, then honed in on the 60 percent of women who express the protein at low to intermediate levels. The vaccine is a mix of the E-75 peptide of the HER2 protein and an immune system stimulant.

If its low to intermediate levels maybe it is for me. I am confused. One note is that if you look at the recruiting criteria - they don't want healthy volunteers - I guess if you have had cancer you are not considered healthy. I do find that slightly ironic. You may call me unhealthy

Also, its all about the bottom line. The DOD developed this vaccine because breast cancer is one of the prevalent diseases seen in military beneficiaries - they want to save money.

Until my doctor can explain this to me, I'll just put it in the "if we can't kill them, lets confuse them" category for now. I see my oncologist in March, I'll try to stretch my tiny chemo brain to remember it until then.

That pesky mammogram controversy

Here is another article telling us about the benefits of mammograms. It says that after following women for 15 years, 86% of the ones whose breast cancer was discovered by mammography were still alive vs. 66% of the women whose cancer was found through other methods.

How many times do we need to say this? Mammography is beneficial and insurance companies and government insurance agencies who only want to cover mammograms after age 50 or only every few years instead of annually, are just being cheap and sacrificing women's lives.

Allow me to simplify:
- there is a test to screen for a deadly disease that occurs more and more frequently after age 40
- women who get the test are more likely to survive the disease as they are diagnosed earlier
- women who get the test are more likely to have lower medical care costs as they are diagnosed earlier
- the test saves lives and costs

And where is the problem?

Prevention vs. screening

We have been on the screening, screening, screening trip for a long time. Everyone is up on the controversy about mammograms at 40 or 50 and MRIs as a screening tool. We also are all up in arms every time the FDA changes a ruling on a cancer drug - is Avastin really helping breast cancer patients? But aren't we forgetting one teeny, tiny thing?

Prevention is important too. We all know the basics - eat your vegetables, don't get fat, be sure to exercise, don't smoke, don't drink, blah, blah, blah. But do we do that most of the time? Yesterday, being Thanksgiving doesn't count, in terms of taking care of ourselves. It was a holiday. We are not perfect people and we are allowed to overindulge once in a while in all the bad things - fatty foods, buttery sauces, gravy, ice cream, pie, cheese, wine, etc. But we can't do this every day. We need to be good most days. This means no fast food, nothing greasy, no big restaurant meals, etc.And we need to get our exercise.

There has been so much talk about research and screening and treatment but we also need to remember the bigger picture. Cancer has risk factors that you can reduce, even though we can't eliminate them, by taking care of ourselves. I think I have overlooked this as well until I was reminded by this article that I read this morning. As we live in a society with ever increasing waist lines, we need to remember that with increased weight comes increased risk of ailments - not just diabetes but also cancer and more.

So now that we have started to digest our big meals from yesterday, we need to get back on track and eat healthy, get moving, and think prevention.

An ounce of prevention beats a pound of cure

We get our flu shots and other lovely injections to prevent 'bad' things. Now 'they' (as in the big mysterious them a/k/a big brother) tell us that Tamoxifen and aromatase inhibitors can help prevent breast cancer in women who are high risk. And if you take a pill for five years you get another 15 years, 20 years total, of 50% or more risk reduction. Now that is pretty good news I'll say. If I could have prevented my breast cancer, I would have. But I was basically at a normal risk level so I wasn't a candidate

But the article adds that there are risks of side effects from the medications. Tamoxifen can cause uterine cancer or blood clots. Aromatase inhibitors can cause hot flashes, bone loss, muscle cramps and other little fun things. Side effects are side effects. I do not think they are a reason to stay away from a medication. First of all not every one gets them. If they did, the drugs would be off the market. If you have to deal with hot flashes for five years but then significantly reduce your risk of cancer for another 15, I'll take hot flashes over cancer any day. If one drug does not work for you, there are often substitutes that can be made. And if you are on the medications you will be well monitored.

My take on drugs that are recommended to me is that I will try them and if I can't cope with the side effects or don't like how I feel, I go back to my doctor and ask for a dose adjustment or a substitute medication. A medication is taken for a purpose and which is the lesser of two evils - the side effects or the original ailment?

A pound of cure for breast cancer often includes chemotherapy as well as radiation and surgery. Surgery leaves scars. Radiation can leave skin and other issues. Chemotherapy can leave blood issues, and chemo brain. Now that it has been documented by Fox News, we can confirm that chemotherapy causes chemo brain. So not only do you get to be on the cancer roller coaster for life but you lose some of your marbles, a/k/a brain cells, during treatment. But my chemo brain has created an endless supply of humor for my husband as he laughs at my latest brain freezes, and I'm not even a politician.

I did the exercise, eat right, take care of myself life style, but apparently it wasn't enough. I want a magic pill that prevents everything - or are those called vitamins?

Cancer treatment, cancer cure, and cancer cause

Yesterday I went to a free conference on the future of cancer care sponsored by the hospital I go to. I think I blogged about it before. But it was yesterday, I went and enjoyed it. I learned a lot. (And I learned I should not have sat in a crappy conference chair for four hours because it made my back hurt - a lot! But I took my drugs and suffered in silence until I got home and could whine to my husband and get an ice pack.)

The conference had three one hour sessions. You could choose your topics for the first two - I chose the breast cancer ones because I don't have lung or prostate, and the other stuff I didn't care to learn about.

The first one I went to was actually given by my surgeon and my medical oncologist. The surgeon talked about how breast cancer surgery has changed and is still changing. It is now focused on less is more. Studies have shown that in the majority of breast cancer diagnoses, a lumpectomy with radiation is just as good as a mastectomy. There is also concern for not taking the underarm lymph nodes even if there is cancer in 1-2 sentinel nodes. So now, even though I had one positive node, I probably would not have had the axillary node dissection which has since resulted in lymphedema. Also, decisions on chemotherapy and adjuvant (Tamoxifen/aromatase inhibitors)

The next session was by the head of the radiation oncology department. Times have changed here as well. Starting early this year, they are now offering partial breast radiation instead of full breast. The theory now is that they only need to target an area around the original tumor that is 1 cm around it. As opposed to radiating the whole breast which is more painful and takes weeks. The partial breast treatment can be completed in one week with twice a day treatment. This has been available in certain parts of the country in trials and not as a standard treatment until very recently. I probably would have had partial breast radiation as well. The decisions on partial or whole breast radiation are designed to involve the patient as much as possible. The focus is on educating the patient, getting them involved in decisions so they can regain some control over their bodies.

The final presentation was by Dr. Susan Love, who was very funny and provided a great presentation. She said the focus now is not as much as where the tumor is in your body - breast, lung, stomach - as much as its characteristics a/k/a hormone receptor status. Breast cancer is not the only kind of cancer that has hormone status.

In addition, she said there is now thought that cancer might be caused by a virus. A lot of research has been done over years and decades on finding a cure for cancer which we still don't have. But what if research changed and focused on finding the cause.

Using cervical cancer as an example, it has been found to be caused by the Human Papilloma Virus (HPV). Once it was found to be caused by a virus, a cure was developed. She is working on developing her Army of Women (www.armyofwomen.org) where she wants to have a million women and men to participate in surveys and studies that help figure out why some women and men get breast cancer and most don't. (Join if you haven't.) One of her theories is that if researchers had only focused on rats and mice in a lab, they never would have discovered HPV - rats and mice can't get the HUMAN Papilloma Virus because they aren't human....

Another take away from Dr Love is on prevention of breast and other cancers. The three key areas are:

• weight - not necessarily what you eat but what you weigh and not gaining weight.
• exercise - 3 hours each week of getting your pulse rate up.
• stress - we can't prevent stress but we can handle it better - this means therapists, talking, support groups, prayer, meditation or whatever works for you.

So get an exercise group together to workout, you keep your weight down and have an instant support group - her idea, not mine - but I like it and might steal it.

Overall, I was very surprised to learn how much had changed and how much hasn't changed in the past four years. Cancer studies can take years or even decades to publish results as they often follow the participants health for a long time after. This can slow treatment changes. But change has happened.

One note on the conference is that conferences run by doctors and hospitals provide healthy food. I went and was craving a chocolate chip cookie. I figured they would have something close to that. I was wrong. They had yogurt, 'shooters' of nuts and dried fruit and cup up apples with peanut butter. After they had had cheese and crackers and veggies and dip. I saw some fried egg roll things being passed around but there wasn't a chocolate chip in sight. In my evaluation I asked that they repeat the conference annually. Maybe I'll email and request cookies for next year - cancer people need cookies and Dr Love said it wasn't what we eat as much as what we weigh and I do have occasionally cookie cravings even though I eat my vegetables.

Another reason to exercise

Perhaps I was actually doing something right. Before and during treatment, and even for a while after, I went for a daily walk. During treatment, I would drag my body outdoors to get some fresh air and exercise for a 30-45 minute walk. The only days I didn't go for a walk was when I was hospitalized. I may have been walking slower than before diagnosis, but I was moving.

I was always encouraged to do so by the doctors and nurses. Other people in treatment would look at me like I grew two heads - you mean you didn't stay home and take a nap? At the time I was doing it because it was part of my daily routine to go for a walk and cancer wasn't going to upset my routines - even if it screwed up the rest of my life. In addition, it helped with that lovely treatment side effect - constipation - that they never told you about.

Now, perhaps it looks like I was doing something right after all - they (the omnipresent) are recommending that exercise be part of cancer treatment. Patients should no longer be told to take it easy. Of course there is disagreement about how much benefit there is - whether it is a 40% risk reduction for a recurrence for breast cancer people or less - but they all agree exercise is good.

I admit I no longer go for a daily walk. The reason is a daily walk wasn't reducing my personal flabbiness level enough. Last winter I took a Pink Program exercise class offered at the local Y for the ginormous price of free for breast cancer people. Then I decided I needed more and joined a gym run by physical therapists where I get a personalized exercise program that takes into account all my personal health issues and limitations, is populated with an average age of 70, and oxygen tanks, walkers, and wheelchairs abound. When I go there three times a week, I do 40 minutes of cardio, followed by two sets of 15 of six exercises on machines, followed by more abuse with weights, etc and leave a sweating ball of exhausting after about 1.25 hours. My personal flabbiness level is being impacted by this so I am happy.

And now it looks like for once in my life I am doing something right. Today, we are back from a vacation where we managed to eat vast quantities of food with my husband's relatives and I am going to the gym after I face the loads of laundry that have piled up.

But I don't really like broccoli

The one thing I have in common with the former President George H.W. Bush is that I am not a huge broccoli fan. I eat it, sometimes. But not all the time.

My parents have an on-going issue with broccoli. My father is convinced it is good for him and he should eat it regularly - a couple times a week is fine with him. If he goes to a grocery store, he will come home with broccoli. If he goes to a restaurant which has a dish with broccoli in it, he will order it. My mother, on the other hand, would prefer to eat it less frequently - once a week at most.

Bad news for my mother. The latest research shows that broccoli and other cruciferous vegetables contain Sulforaphane, one of the primary phytochemicals, which has been shown for the first time to selectively target and kill cancer cells while leaving normal prostate cells healthy and unaffected. If my father learns this, I am afraid he will want it daily. That would be pretty darn boring as far as I am concerned.

Additionally, "The findings, made by scientists in the Linus Pauling Institute at Oregon State University, are another important step forward for the potential use of sulforaphone in cancer prevention and treatment. Clinical prevention trials are already under way for its use in these areas, particularly prostate and breast cancer. "

Luckily there are lots of other cruciferous vegetables out there to eat besides broccoli. A partial list from wikipedia includes: horseradish, collard greens, Chinese Broccoli, cabbage, brussel sprouts, broccoflower, cauliflower, kohlrabi, bok choy, komatsuna, mizuna, broccoli rabe, flowering cabbage, chinese cabbage, napa cabbage, turnip (roots and greens), rutabaga, Siberian Kale, mustard cabbage, arugula, water cress, radish, daikon and wasabi. We have been eating komatsuna and mizuna recently as I can get them from our local farmer's market. We use horseradish as a condiment regularly and cauliflower, kohlrabi, bok choy, kale, radishes, arugula and others cross our table fairly frequently. So I will skip the broccoli and stock up at the farmer's market for the summer.

I have a few ways of cooking all these greens that I like. I usually start with some sesame oil and toss in some chili paste for some zing. My brother in law likes to put vinegar on his which is also pretty good. And since everything is better with butter, that's always another option.

I am a fan of eating right but sometimes I think that if I ate the 'right things' all the time, all I would eat would be the 'right things' and not be able to fit in the other foods that I really like to eat without completely going off my diet. But I can fit in more green vegetables through the summer when they are fresh and tasty. But I'll skip the broccoli when I can.

Yes, my mother reads my blog so I am sure I will hear about this.

More medical/cancer news

I seem to be in a summary mode but there are three more articles of note this morning.Some I understand and some I don't. Well maybe I sort of understand these but not completely. Is it chemo brain? Are they complicated? Or am I not as smart as the average bear?

- The government is mandating doctors and hospitals convert to digital records in five years. But the incentives don't kick in until next year and the deadline is 2015. (In my math, this is 2011 and 5+2011=2016 but we have always known the government has its own math system.) I do like this idea that medical records will go digital. I find it absolutely ridiculous that patients are forced to carry big files of confidential paperwork from appointment to appointment. I remember in the past if I was going from one appointment to another in the same hospital, sometimes I had to carry my own file with me (and got to read parts of it - one time I went to the cafeteria and sat down for some heavy reading/deciphering of doctor scribbles.) But if it you have to take them from one office to another in separate facilities, how do doctors refer to your files when you call in with questions if you file is elsewhere? If its in the computer they can look it up easily and see all your issues in one place.

- There are new horizons in place in determining how cancer spreads. (Warning, science lesson in this article.) Basically (what I think I have figured out from this) is that it is now known that cancer cells hijack the development of cells and takes them back to stem cells and turns them into other thingies and it all gets really confusing... But this is considered a major breakthrough in that cancer researchers now have another direction to go in, I think. This is complicated and requires lots of thought to decipher but it sounds very promising.

- There is another attempt to explain cancer risk reduction. I am very confused on this risk reduction business. I mean I understand that if you don't smoke you reduce your risk of lung cancer, etc. But I don't understand what they mean by a 1.6% or 2.4% risk reduction. What exactly does that mean? If you have a 10% lifetime risk (I am making this up) of getting breast cancer, does a 1.6% risk reduction mean you can reduce your risk to 8.4% (10-1.6=8.4) or to 9.84%. (10%x1.6%=.16% and 10%-.16%=9.84%) I don't get it. This article tries to explain it here: "For instance, in a general population of 1 million women, even a 1.6% absolute risk reduction amounts to 16,000 fewer cases of cancer. In contrast, a 3.2% reduction in a higher-risk group – postmenopausal women with a family history – amounts to only 2,560 fewer cases, according to the model." The first sentence gives me a clue but the second sentences confuses me. Brain overload. I think I need to ask my doctor to explain this as she would to a five year old.

Maybe I can just say that cancer is confusing to all of us.

Another day = more confusion

As I wake up this morning (after 11.5 hours of sleep) I find three articles on the same topic - Aromasin, an existing drug for breast cancer treatment may help prevent it.

The first part of my confusion. Aromasin is in a class of drugs called aromatase inhibitors. I am on a different one called Femara. I was told they were all the same and I would start with Femara and if I had reactions to it or handled it badly, they would switch me to another. My confusion here is if they are the same, why isn't Femara and the other AI included in this article? Or if Aromasin is different than the other two, should I switch?

The second part of my confusion is that I thought I was taking it as part of the prevention plan against a recurrence in the first place. I did take Tamoxifen for two years and then am on Femara for three years total, two more years. Is this study only for people who are at risk but never had breast cancer in the first place? I am considered at risk because I had it once so should I take switch to Aromasin and stay on it for life?

I will need to discuss this with my oncologist when I see her in August. But that would require me to REMEMBER to tell her about this. Chemo brain prevents me from remembering more than the basics in life sometimes. Last week my husband says he likes being married to someone who is more of a space shot than he is.

I just believe its all a part of the evil conspiracy to confuse patients. Destroy their brain cells with chemo and then give them conflicting information they can't understand and will forget to ask their doctors about. I don't understand, I am confused.