Beauty & the Beast of Breast Cancer

In today’s celebrity-obsessed culture, women are pummeled with the message that to be loved and happy, they must possess beauty and physical perfection.

It’s hard enough for the average person not to succumb to this pressure, but how much more for women battling cancer.

Breast cancer treatment can assault a woman's femininity, sexuality and attractiveness.

I asked my friend, Virginia Apperson, how to deal with this. I figured she was the best person to turn to since she's a Jungian psychoanalyst and author of the book, “The Presence of the Feminine in Film."

“We’re a superficial culture that sets certain requirements as to what is beautiful—especially for women—and if we don’t fall into these standards, we don’t feel like we have value,” she said.

"But the irony is that it’s out of suffering and illness that we deepen ourselves and discover aspects of ourselves that are more genuine than striving for outer perfection."

The reality is, there’s nothing pretty or easy about cancer treatment. However, in the midst of it, there are choices as to how to endure, she pointed out.

Virginia said you pretty much have to put on blinders and 'start living in another ‘universe’ (how Jungian). In other words, find a place where not being perfect is acceptable.

"Surround yourself with others who can commiserate with your issues, and can acknowledge what you’re going through and grieve with you," she advised. That can be found with friends, support groups, or with a therapist or a pastor.

She also suggested expressing your feelings in "physical form"-- as she put it-- through writing or art.

“We’ve so sanitized our world and been told not to have bad feelings. But, the hope is, if you confront the despair and express it, it ceases to have power over you.”

Instead, she said, it could give you a deeper understanding of who you are and what's important to you.

Another tip - avoid magazines and TV programs that emphasize beauty and glamor. There's nothing worse than picking up a copy of Vogue with a cover of an emaciated teenager airbrushed to perfection.

Virginia encourages women to seek inspiration from role models in literature and film "who allow their inner self to be valued"--"characters who have the fierceness to say, ‘I’m not playing along!’ "

A good example is the movie, "Cold Mountain." Ruby -- who is plainly in need of a makeover--displays "a life force that’s unstoppable,” as Virginia describes it. Ruby is paired with Ada, who although is beautiful, finds that beauty won't keep her alive. Ada learns how to be strong through Ruby and Ruby learns how to dress better through Ada, which all leads to a somewhat happy ending.

So toss out your latest copy of People and watch an old Betty Davis movie instead. After all, Betty was not the beauty that many starlets of her time were, but she outshone and outlasted them all.

Breast Cancer Makes You Fat

It's bad enough one has to suffer through cancer, but to add insult to injury, it can make you fat.

Jill Binkley, a physical therapist and breast cancer survivor, explains why.

Jill founded TurningPoint Women's Healthcare (http://www.myturningpoint.org/), a comprehensive rehabilitation program for breast cancer patients. It provides physical and massage therapy, as well as nutrition and exercise counseling.

“About 60 percent of women with breast cancer gain weight, which most women don’t expect…in fact, they assume they’ll lose weight,” she says.

But, due to metabolic and chemical changes from chemotherapy--plus, menopause kicking in -- the scale tips toward the upward direction for most women. Add a sizable dose of steroids to help the medicine go down and you're looking at a new dress size (or two).

A solid nutritional plan and regular exercise program -- 40 minutes per day 4-5 days per week--can help stave off unwanted pounds.

This is not only good for your wardrobe, but for your health as well--since weight gain is a risk factor for developing lymphedema and cancer recurrence.

Dragon Boat

I obviously need to get out more. I had never heard of a dragon boat, much less dragon boat racing. But to my surprise, it's quite the rage, especially among breast cancer survivors.

Rowing, in general, is the perfect exercise for the area that's been marred and scarred by surgery since it builds and strengthens chest-arm-back muscles. In addition to fitness, the dragon boat brings survivors together for fun, camaraderie and an enhanced body image.

Besides rowing for fitness, dragon boat teams participate in races to raise money for breast cancer research. So grab an oar, smear on some sunscreen and hit the water. It could benefit your life and others. (www.myturningpoint.org/DragonBoatAtlanta).

Benefits of PT and MT

I recently discovered a new organization aimed at helping breast cancer survivors recover from treatment.

TurningPoint Women's Healthcare (http://www.myturningpoint.org/) is a comprehensive rehabilitation program that offers physical therapy, massage therapy, exercise and nutritional advice and professional counseling.

It was founded by Jill Binkley, based on her experience as a professional physical therapist and breast cancer survivor.

“Anyone recovering from knee surgery is automatically sent to rehab afterwards,, but this isn't the case for breast cancer patients,” she says.

Binkley cites numerous problems resulting from breast cancer treatment, including limited range of motion, lack of strength and flexibility, and pain caused by scarring and swelling of tissues.

“Anywhere from 30 to 50 percent of survivors up to four years post-op have shoulder, breast/chest wall pain, as well as pain in the donor site from reconstruction,” she explains. “Overcoming pain and physical limitations can help women resume their normal activities."

Getting your body "back to normal" after all it's been through and helping you resume your life can also help ease feelings of anger, hopelessness, powerlessness and frustration that your body isn't the same as before treatment. And we all know what that feels like.

Physical therapy and massage therapy can help with range of motion issues and pain control.

Plus, massage has an additional benefit, she points out: “There are several strong studies that show massage during and after treatment increases the immune system function."

As if we really needed an excuse to get a massage...

The Real Thieves

Our fast-paced and chaotic way of living--with traffic and telemarketers and texters and twitters--along with the stress of the economy and the total uncertainty of what the future holds has gotten to me lately. You could say, I've been on edge.

Then, this weekend, Mom told me that her neighbor--who is my age with a 14-year-old daughter--is on her 3rd round of chemo for breast cancer. What she has gone through over the past year, and continues to go through in fighting this disease, floors me. I don't know that I would have her resiliency to endure so much for so long.

I was quickly reminded of how I felt when I was diagnosed as Stage 3 over eight years ago, before I began treatment, and wondering if I would be alive a year later. I remember that all my daily irritations and problems and worries fell away. They simply didn't matter. They lost their power. Only living mattered.

And when my frustrations and bad attitudes vanished, I became intensely aware of the beauty and wonder of life. I realized--as so many cancer survivors do--that focusing on all the negatives distract you from the richness of all that's good in the world. They rob you from living.

I love how the priest in Les Miserables answers people who question his decision to not bolt his door at night to prevent robbers from entering. He responds that it's not thieves who steal silver that we should fear. Rather, it's the darkness of our souls that truly robs us of all that's valuable.

So, I am once again reminded of how precious life is--despite it's constant disappointments and challenges. And in today's environment, there are many. But it's amazing how gratitude can instantly reverse your viewpoint.

The Truth Behind Cancer Studies

I typically get an eye-roll from my oncologist whenever I present her with a ripped out newspaper article about a just-released study announcing new cancer findings.

With all the health news accessible these days, you'd think we'd be medical experts. But, in reality, the opposite is true because so much information that's reported is confusing and even incorrect.

How do you know which studies are valid? The starting point is understanding how health-related research is conducted, so I tapped my trusty source, Greg Orloff, who teaches the cancer of biology at Emory University in Atlanta, and has an award winning website about cancer (cancerquest.org).

"There's always an element of sensationalism in the media because that's how they sell their publications," Orloff says. "Consumers need to be able to interpret a study so they can factor this information into their decision-making."

He suggests the following to determine a study's validity:

1. Determine the study's purpose. Orloff says it's expensive to follow 20,000 people over 20 years.

"As a result, researchers attempt to extract as much information from a study as possible and then use the findings for multiple purposes."

A study may be designed to find out one piece of information (whether smoking increases the risk of lung cancer), but other researchers can re-analyze the same data asking different questions and come up with additional conclusions (smoking causes an increase in heart attacks).
"You need to look at the information collected and make sure that researchers are isolating the information you're interested in from other study conclusions. This is difficult to accomplish -- it's hard to analyze one single thing because humans are complex. It could be something other than what's being studied that's contributing to the outcome."
For example, let's say you're looking at the effect exercise has on breast cancer. You conduct a study involving 2,000 people and look at those who exercise 5 times a week, those who exercise 1-3 times a week, and those who don't exercise at all.
Then, you observe the rate of breast cancer occurrence over time. You may find that those who exercised 5times a week had fewer occurrences of breast cancer than those who didn't exercise at all.
But what do you think the chances are that people who exercise a lot also have a healthier diet than those who don't? So another factor -- diet, which is not what the study is about - may play a role in the study's results.
It's a matter of asking the right questions about the study.
2. Look at how the study was designed and conducted. To interpret the findings of a health-related study, consumers need to understand the nature of research and what it entails. Consider the following questions when giving credence to a study:
* How reliable is the information gathered from the participants? People can make mistakes (or not tell the truth) in recalling lifestyle choices and their family health history. This can affect a study's outcome.

* How many people did the study involve? The larger the study, the more credible the information. If the study was not conducted on a large enough population, then you should hold off making a conclusion.

* What was the length of time it was conducted? The results will differ significantly from a 5-year study versus a 20-year one.

"Often, evidence is derived from the preliminary stage -- such as 3 years into a 20-year study -- which can be misinterpreted and hyped by the press, eager to report the latest news. A longer study is better at providing the actual outcome."

* Who participated in the study? Socioeconomic and cultural variations between one population and another can impact results. A study should represent the larger population in order for researchers to make a general, relevant statement. But this is difficult to achieve.

"The challenge is how do you randomly select a population to study? Let's say you decide to study people living near a major college campus. But the problem is that a better-educated, higher-income population lives in that area, and that means they make very different lifestyle choices (such as more visits to the doctor) versus the average population. This is just one factor that will produce a bias in the study's results."

* Who conducted the study and what was their motivation? Is it to convince you to buy their product?

3. Know the difference between "correlation" and "causation."

Correlation -- is an association between two things. For example: Men who exercise have fewer incidents of colon cancer. But is it because they exercise, or that they are eating a better diet? The association between exercise and lack of colon cancer is real, but is exercise actually causing these positive results?

Causation--is a factor that leads to a specific outcome, such as smoking causes lung cancer. You can get lung cancer for other reasons, but scientists have proved that mutagens in smoking do cause lung cancer.

People often misuse those terms and misinterpret results, making a conclusion because they assume causation and correlation are the same.

4. Are studies conducted on animals relevant? Since human studies are difficult and expensive, animal studies can be beneficial since researchers know the genetics and can completely control behavior (how much daylight exposure they receive, diet, hours of sleep).

"For want of a better model system, animals are valuable," says Orloff. "People tend to dismiss animal studies, but researchers can still observe the effects of a particular treatment, which could be applicable to humans.

"At the same time, if a treatment works in an animal model, it may or may not work in humans because we're genetically designed differently."

With animal models, you need to ask if the doses that researchers are giving a reasonable amount.

5. Understand the statistics. "Studies ultimately come down to statistics, and most often, reporters and readers don't understand what those statistics mean. Statistics exist for any study with credibility.

"So, if you are interested in pursing a lifestyle change based on a study, you need to know the numbers that support the findings - is it statistically significant?"

Medical journals are a good place to find a study's statistics.

"And even if you can't interpret the data, the more information you can access, the better you are armed to ask the right questions of professionals (your doctor), who can give you the best answers."

So, despite the eye-roll, it's a good idea to check with your doctor regarding information you find in the media. They are the best source about what's true and false.

Cancer 101

Every day, it seems, I get an email from a well-meaning friend about a new cancer study concerning grapefruit juice, PET bottles, red meat...the list is endless. Or, a news article saying that mammograms and self-examination are a waste of effort.

Since I've recently received my umpteenth email about another presumable cancer-causer, I thought it was time to feature an interview I had with Dr. Gregg Orloff. Orloff teaches the biology of cancer at Emory University in Atlanta, and has developed an award-winning website that explains the biology of cancer: http://www.cancerquest.org/.

"Of all the environmental and behavioral factors that have been investigated for cancer, only a few have shown a clear link," Orloff says.

"It's difficult to make hard conclusions about certain activities and their impact on cancer because studies to-date haven't involved a large enough population or haven't been conducted for a long enough time period to offer anything definite. The data simply doesn't exist at this point."

Still, research has uncovered enough implications between particular behaviors and increased risk that it's worth paying attention to how lifestyle choices impact our health, he says. But in order to understand how behavior and cancer are related, we first need to know what causes cancer to form.

The Basics
"Cancer is ultimately a result of DNA damage," explains Orloff.

"We know that cancer is derived from a single defective cell that has multiplied. It occurs when a cell strikes out on its own, resulting in unregulated cell growth. These abnormal cells pile up on each other and form masses, which are commonly known as tumors."

Why does a normal cell strike out in the first place? What causes it to become cancerous?

It happens when a particular set oif genes in a cell are altered by mutagens. And, this is where lifestyle behaviors may play a role in cancer. Mutagens enter the human body by means of inhaling, ingesting and absorbing.

They derive from:
* Chemicals in the diet -- For example, charred meat from grilling (the burning process) can cause the formation of chemicals that are thought to be mutagenic.

* Infectious agents -- A problem can occur when a virus actively alters the cells. For example, cervical cancer may result after infection with the Human Papilloma Virus...a viral infection.

* Chronic infections - Cancer can result in response to an infectino. For example, hepatitis has been associated with liver cancer. When cells are killed by infection, they need to be replaced constantly, so there are high amounts of cell division occurring in these tissues. In addition, the body's immune response to fight infection is producing chemicals that can cause mutations.

* Chemicals in the envioronment -- These can be absorbed or inhaled, such as smog and industrial waste.

In other words, every time you expose your body to a cancer risk -- eating buned meat, inhaling cigarette smoke or absorbing coal tar -- mutagens enter your body. And chemicals that are mutagenic can cause DNA damage.

The Luck Factor
If we all take in mutagens, then why does one person develop cancer over someone else?

"In order for a single, normal cell to turn into a cancer cell, it must acquire five to six different changes from mutagens. So, it's a cumulative effect," says Orloff. "Two people can be exposed to the same mutagen, but in one person, the cell dies or remains the same, while the other perosn acquires a mutation in an important gene and develops cancer.

"That's why you see some people smoke their entire lives and not get cancer, and others who 'do all the right things' develop cancer. Luck plays a big role as to who gets cancer and who doesn't. "

In the Genes
There are genetic components to cancer, as well.

"A person can inherit defective genes -- such as BRCA1--which by itself doesn't necessarily cause cancer," Orloff adds. "But a defective gene can increase your chances that some important key genes will be affected by a mutation, giving you a higher risk for cancer."

Another genetic factor that can impact whether one person develops cancer versus another is possessing better DNA repair genes, which respond to DNA changes differently.

In addition, the way your body processes toxins can affect your chances of getting cancer. For example, the liver has enzymes to process and eliminate toxins -- making them soluble so they can be excreted. But this detoxification process can convert a chemical into a mutagen.

Consequently, two people may be exposed to the same risks, but their bodies may process toxins differently.

Risky Business
Whatever your body's genetic makeup, DNA can be damaged by certain behaviors.

The following factors are known to have an associated risk of cancer because of their mutagenic properties:

* Smoking -- Full of mutagens, smotking as well as second-hand smoke is connected to almost all cancers.

* Sun damage -- UV rays are mutagenic and have been proven to cause skin cancer.

* Diet & obesity -- Obesity carries an increase risk of breast and colon cancers. Certain diets can alter the level of growth factors and nutrients (protiens, lipids, sugars) in the blood, which, in turn, can stimulate normal cells to become cancerous, or cause existing cancer cells to grow.

* Alcohol -- Particularly a risk factor for breast, colon and esophageal cancers, alcohol is toxic and must be detoxified, causing stress on the body. The detoxification process can cause DNA damage.

* Medications -- Certain drugs can potentially cause a problem. For example, female children of women who took DES (now outlawed) while pregnant have higher incidences of cervical and uterine cancer.

Healthy Choices
On the other hand, there appear to be certain behaviors that may help reduce your risk of cancer:

* Exercise - In some studies, exercise has been shown to have positive beneficial effects on breast and colon cancer. The benefits of exercise may be due to a wide variety of effects, ranging from enhanced immune system function to increased GI motility.

* Diet -- Overall, a well-balanced diet with fruits, vegetables and nuts is beneficial. Specifically, foods that contain antioxidants (such as leafy green and cruciferous vegetables) have cancer fighting possibilities.

This is because our bodies produce oxygen radicals, which are highly reactive molecules in cells that act as mutagens and can cause DNA damage. Antioxidants act as interceptor missiles, neutralizing oxygen radicals before they affect DNA.

In addition, studies have indicated that Vitamin D, selenium and calcium might potentially prevent or limit cancer growth.

"None of these things, alone, offers a huge reduction in cancer risk," warns Orloff. "But we know enough from studies to advise people to take care of their body."

The Bottom Line
"There's no holy grail in that if you do this set of behaviors, you won't get cancer," says Orloff. "All you can do is limit your risks.

"It's like avoiding a car accident," he says. "You can limit your risks by wearing a seat belt, not driving late at night, and not driving while talking on the cell phone. But all these things still can't guarantee that you won't get killed in a car accident."

"The same goes for cancer. Individuals have to decide what risks they want to live with."