Foreword xvii
Introduction 1
About This Book 2
Foolish Assumptions 2
Icons Used in This Book 3
Beyond the Book 3
Where to Go from Here 4
Part 1: Knowing About Breast Cancer 5
Chapter 1: Breast Cancer 101 7
Breast Cancer Basics 8
Finding your way around your breast 8
Knowing about breast cancer risk factors and indicators 9
Distinguishing Different Breast Cancers 10
Detecting breast cancer 13
Biopsies and how they work 14
The pathologist and diagnosis 14
Grading and Staging of Breast Cancer 15
Planning Your Treatment 15
Looking at your treatment options 15
Considering breast surgery 16
Treating breast cancer with radiation 17
Treating breast cancer with chemotherapy 17
Treating breast cancer with endocrine (hormonal), biological, and other cutting-edge therapies 17
Treating advanced breast cancer 18
Chapter 2: Risk Factors for Breast Cancer 19
Advanced Age 19
Gender 20
Race and Ethnicity 21
Early Menstruation and Late Menopause 23
Use of Birth Control Pills 23
Genetic Risk: BRCA1 and BRCA2 Genes 23
Poor Nutrition 26
Fats 27
Red meat and processed meats 27
Obesity 28
Smoking 29
Alcohol Use 29
Prior Treatment and Chemical Exposures 30
Exposure to DES (diethylstilbestrol) 30
Hormones: Estrogen and progesterone use 30
Environmental factors 31
Chapter 3: Indicators of Breast Cancer 33
Monitoring Changes in Breast Size and Shape 34
Breast increasing in size 35
Breast decreasing in size 35
Watching for Skin Changes 36
Rash 36
Paget’s disease 36
Skin thickening 37
Cellulitis 37
Mastitis 38
Breast abscess 38
Checking Out Lumps and Bumps 39
Breast masses and fibroadenomas 39
Breast cysts 39
Dense breasts 40
Dealing with Breast Aches and Pains 40
Nipple Changes 41
Nipple inversion 41
Milky nipple discharge 41
Bloody nipple discharge 42
Part 2: Diagnosing Breast Cancer 45
Chapter 4: Physical Awareness and Detecting Breast Cancer 47
What to Look For 49
Doing a Breast Self-Examination 50
In the shower 50
In front of the mirror 50
While lying down 51
Breast Cancer Screening Guidelines 52
Mammograms: The Go-to Tool 55
Tomosynthesis (tomo) mammogram 55
Advantages of screening mammograms 56
Disadvantages of screening mammograms 56
How a mammogram is done 58
Other Screening Tests: MRI and Ultrasound 59
Chapter 5: Understanding Breast Biopsies 63
Knowing What a Breast Biopsy Entails 65
Getting the Right Type of Breast Biopsy 65
Playing an Active Role in Your Breast Biopsy: Before, During, and After 67
Preparing for your biopsy and reducing risks and complications 68
Knowing what to expect on the day of your biopsy 69
Waiting for your biopsy results 70
Making Sense of Your Biopsy Results 71
Grasping some basic medical terminology 71
Sorting out the nuances of “abnormal” 72
Most common types of breast cancer 73
Less common types of breast cancer 73
Digging deeper into the pathology report when cancer is detected 74
Discussing your pathology report 76
Discussing next steps if cancer is found 76
The shades of your pathology result 76
Following up when no cancer is found 77
Chapter 6: Stages of Breast Cancer 79
Testing to Determine Stages 80
Overview of Breast Cancer Staging 80
Early 81
Locally advanced 82
Local recurrence 82
Metastatic or secondary breast cancer 82
Deciphering the TNM Staging System 83
Understanding Breast Cancer Stages 85
Stage 0 (zero) 85
Stage I 85
Stage II 85
Stage III 86
Stage IV 88
Part 3: Treating Breast Cancer 91
Chapter 7: Looking at Treatment Options 93
Surgery 96
Lumpectomy or partial mastectomy (breast- conserving surgery) 96
Mastectomy (total or simple) 96
Modified radical mastectomy 98
Axillary lymph node dissection 98
Breast Reconstruction 101
Radiation Therapy 102
Side effects 103
Skincare during radiation therapy 104
Chemotherapy 105
Endocrine or Hormonal Therapy 106
Targeted Therapy: Herceptin and Others 106
Considering Clinical Trials 109
Randomized controlled trials (RCT) 110
Placebos and double-blind trials 110
Length of clinical trials 111
Chapter 8: Breast Surgery 113
Types of Breast Surgery 114
Preparing for Surgery 115
Talking to your surgeon before surgery 116
Pre-surgical restrictions 117
Special Pre-Surgery Concerns 118
Alcohol consumption 118
Smoking tobacco or cannabis 119
Sleep apnea 119
Following a pre-surgery checklist 121
During the Surgery 122
Post-Surgery Tips 123
Drains and drips 123
Going home 124
Restrictions on activity 124
Chapter 9: Radiation Therapy 127
How Radiation Therapy Works 128
Planning for Radiation Treatment 131
Things to Do before Radiation Therapy 132
Post-Radiation Skincare 133
Radiation Therapy Side Effects 134
Skin reactions 134
Change in breast size and consistency 134
Swelling or edema of the breast 135
Pain in the breast area 135
The Importance of Exercising 135
Warm-up and cool down exercises 135
Basic exercises to do in the first week after surgery or radiation and beyond 136
Advanced exercises for the second week after surgery or radiation and beyond 136
Tiredness and fatigue 137
Lymphedema 137
Change in breast shape, size, and color 137
Hair loss in the armpit or chest area 138
Sore throat 138
Late side effects 138
Chapter 10: Chemotherapy 141
Different Types of Chemotherapy and How They Work 142
How Chemotherapy Is Given 146
Common Side Effects of Different Chemotherapies 147
The “Chemo Brain” Effect 149
Understanding the Oncotype DX Test 150
Who should have an Oncotype Dx test? 151
How does Oncotype DX work? 151
Interpreting the recurrence score 152
Understanding the MammaPrint Test 152
Interpreting MammaPrint results 152
Preparing for Chemotherapy 153
Chemotherapy before surgery: Neoadjuvant chemotherapy 153
Chemotherapy after surgery: Adjuvant chemotherapy 153
Good Questions to Ask Your Doctor 154
Chapter 11: Endocrine, Biological, and Cutting-Edge Therapies 155
Endocrine Therapy in the Treatment of Breast Cancer 156
Side effects of endocrine therapy 157
Preparing for Endocrine Therapy 158
Endocrine therapy before surgery 159
Endocrine therapy after surgery 159
If you can’t have surgery 159
Asking plenty of questions 159
Biological or Targeted Therapy in the Treatment of Breast Cancer 160
Types of biological therapies 161
Trastuzumab and pertuzumab: Monoclonal antibodies 163
Immunotherapy and Cancer Vaccines 164
Cancer vaccines 165
Cancer treatment vaccines 165
The making of a cancer vaccine 165
Cancer vaccine side effects 167
Precision Medicine 168
Benefits of precision medicine 168
Emerging Therapies 168
Targeted therapy: Immunoliposomes 169
Cell signaling 169
Chapter 12: Breast Reconstruction 171
When Should You Have Breast Reconstruction? 172
Immediate breast reconstruction 173
Delayed breast reconstruction 175
Having both breasts removed 176
Methods of Breast Reconstruction 176
Breast implant reconstruction 177
Autologous breast reconstruction 179
Autologous tissue with implant reconstruction 180
Risks of Breast Reconstruction 183
Questions to Ask Your Plastic Surgeon 184
Choosing Among Your Options 185
Chapter 13: Treating Advanced Breast Cancer 187
Treatment Decisions and Treatment Options 188
Treatment decisions for advanced breast cancer 189
Treatment options for advanced breast cancer 189
Endocrine or Hormone Therapy for Advanced Breast Cancer 190
Chemotherapy for Advanced Breast Cancer 191
Biological Therapies for Advanced Breast Cancer 193
Role of HER2 receptors in advanced breast cancer 193
Trastuzumab (Herceptin) 194
Pertuzumab (Perjeta) 195
Denosumab (Prolia, Xgeva) 196
Everolimus (Afinitor) 197
Other issues with biological treatment 199
Radiation Therapy for Advanced Breast Cancer 201
Radiation as injection 201
Side effects of radiation for advanced breast cancer 201
End of Life Concerns 202
Communicating to Providers 203
Part 4: Dealing with Breast Cancer and Everyday Life 205
Chapter 14: Psychosocial Concerns and Breast Cancer Diagnosis 207
Fear and Worry and Their Physical and Emotional Toll 208
Functional Concerns: Work and Home Life 210
Functional capability for occupational activities 211
Fear of infertility 212
Worrying about work and finances 213
Spirituality 214
Seeking Support 215
Purpose and benefits of participating in a support group 215
How support groups are structured and organized 215
How to find a support group 216
Chapter 15: Managing Stress 217
Incorporating Relaxation Techniques 220
Visualization exercise: Lying in a meadow 222
The Importance of Sleep 222
Spirituality and Meditation 224
Tips for finding comfort, meaning, and spiritual support 224
Call for inner peace 225
Health affirmation 226
Chapter 16: Coping with Changes after Treatment 227
Cancer-Related Fatigue 228
Recognizing cancer-related fatigue 228
Managing cancer-related fatigue 229
Dealing with Hair Loss 230
Caring for your hair when it begins to grow back 231
Talking with your healthcare team about hair loss 231
Addressing Skin Changes 232
Understanding discoloration and hyperpigmentation 232
Experiencing Numbness and Tingling: Peripheral Neuropathy 233
Being at increased risk for peripheral neuropathy 234
Knowing the symptoms of peripheral neuropathy 234
Reducing the effects of neuropathy from chemotherapy 235
Relieving constipation induced by neuropathy 236
Checking out medications and treatments prescribed for neuropathy 237
Coping with Lymphedema 238
Knowing the symptoms of lymphedema 239
Treatment for lymphedema 239
Taking preventative measures 240
Resources for lymphedema management 241
Changing Tastes and Smells 242
Countering Changes in Appetite 243
Dealing with weight gain 245
Managing weight gain 246
Dealing with Diarrhea 247
Chapter 17: Cancer Treatment, Fertility, and Sexuality 249
Infertility and Breast Cancer 250
General causes of infertility 250
Fertility and cancer treatment 251
Permanent infertility 253
Temporary infertility 253
Early menopause 254
How to help preserve your fertility 254
Tissue banking and fertility preservation 255
Alternative complementary and alternative medicine fertility treatments 256
Good clinical care practice for infertility 257
The BETTER model approach 257
The emotional side of fertility issues 258
Pregnancy and cancer 258
Sexuality and Breast Cancer 259
Physical effects of cancer treatment on sexuality 259
Sexuality and intimacy 262
Sex after cancer 263
Dating after cancer 265
Chapter 18: Making Healthy Lifestyle Changes 267
Healthy Lifestyle Changes to Lose Weight 268
Healthy Lifestyle Changes for Anxiety and Depression 269
Exercise 269
Quitting Bad Habits Like Smoking, Drinking, and Drug Abuse 272
Quitting smoking 272
Limiting or avoiding alcohol 274
Treatment for alcoholism 275
Overcoming drug abuse 276
Maintaining Good Nutrition and Diet 277
Foods that can increase or lower estrogen 278
Cooking and food preparation 279
Weight Control and Activity 280
Concrete steps to take toward healthier lifestyle changes 281
Quick meals to make for healthy living 282
General Health Guidelines for Optimal Health 283
Part 5: The Part of Tens 285
Chapter 19: Ten Inspiring Breast Cancer Survivors 287
Helen Hosein-Mulloon 288
Linda Doyle 290
Felicia Smith 292
Kelly M 293
Joy Walker 295
Abbie Savadera 296
Rhonda M Smith 297
Rosa Amelia Tena-Krapes 298
Linda Butzner 299
Alice Loh 300
Chapter 20: Ten Ways Family and Friends Can Help You 303
Learn to Listen 303
Be Your Advocate and Note Taker 304
Keep It Lighthearted 304
Distract You with a Surprise 305
Help You Understand That You Need Help 305
Leave a Message after the Tone 305
Ask You Before Bringing Food 306
Buy You Groceries Instead of Bringing Prepared Foods 306
Help Make Life Normal for Your Kids 306
Don’t Forget You 306
Chapter 21: (At Least) Ten Ways Life Can Be Better After Cancer 307
Adopting an Attitude of Gratitude 308
Enjoying the Moment 308
Knowing Why You Deserve Happiness 308
Learning about Your Health 309
Learning to Pick Your Battles 310
Learning to Be in the Here and Now 311
Engaging in Positive Self-Talk and Conversations 311
Managing Physical Changes 312
Achieving Self-Acceptance and the New You 313
Following a Cancer Survivorship Plan 314
Screening for Breast Cancer and Wellness 315
Appendix A: Breast Health Glossary 317
Appendix B: Support Groups, Resources, and Organizations 327
Index 337
