Breast cancer survivors: Am I cured yet?

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[Republished from DocGurley.com with permission]

October has become so synonymous with Breast Cancer Awareness month that it's almost a total pink-out. Signs, stores, and even scarves urge us to stamp out breast cancer. And following on October's (high) heels this year was the Mammogram Media-Monstrosity (for a bullet-sized version, check out #9 in the Doc Gurley Year in Review: Top Ten Health Lessons of 2009, or, for a more detailed look at the issue, check out the article, Battle of the Breasts: 16 Crucial Facts for You to Know). Now that we're into a new year, it's a good time to reflect on, well, life. Specifically, life after breast cancer. What with all the hula-baloo about prevention and screening, I'm thinking that the people who've already been diagnosed might have been just a wee bit overlooked.

So how do you embrace health post-breast-cancer? And what's with the weird reluctance of doctors to use the C-word ("cured")? Are there important, simple steps you can take to tilt the odds in your favor for living well? These are the kinds of issues you don't hear so much about in the news - despite the fact that shockingly large numbers of us know and love a mother, sister, friend or daughter who's been diagnosed. To cover some of these issues, I had the pleasure of talking with the charming Zennie - who's very interested in this topic on behalf of his mother. More and more we LIVE with diagnoses and diseases. And that's a good thing. But often we're left trying to decipher life-style advice, and, as research shows that our groups of family and friends is crucial to success, lots of us want to know what might help. So here are some recent, positive research results that you can consider when it comes to life after breast cancer.

Obligatory disclaimer: An article (ANY article) is, in no way, a replacement for actual medical care, and should not be mistaken for personal medical advice. When it comes to random, non-customized medical discussion, take to heart the message that the deep voice says (at the end of gazillions of soft-focus pharmaceutical ads) and see your doctor.

1) The "C-word." Or, why won't my doctor say I'm cured? Doctors don't tend to say that anyone is cured, and even just the absence of that word feels like a heartbreaker for many people. Refusing to say you're cured feels like a HUGE statement that professionals may be lacking-faith in your future. But that's not true. So why won't doctors say it? At it's worst, you could say that doctors don't generally pronounce anyone cured because the doctor is worried it will come back to haunt them if a patient relapses - after all, no doctor can tell the future. At its best, you could say that life is a continuum, that finding a breast cancer and treating it is the beginning of a process - a lifelong process of prioritizing your health. So what kinds of things can a person do to promote health after a diagnosis of breast cancer?

2) Should I lose weight? Exercise? Even at 60? What's clear is that being overweight significantly increases your risk of getting breast cancer in the first place. But what about after you've been diagnosed - should you lose weight? The answer is still being debated. But some well-done research shows that obese patients have worse outcomes, even after diagnosis, and even when you control for the same stage of tumor. What is clear is that promoting your health is a good thing. Eating well, walking everywhere, lifting weights three times a week for as little as 20 minutes at a time - all those things are important to your health. Simple steps can make a big difference - cut out all sugar drinks, including those with sugar-substitutes (become an unsweetened water/tea/coffee-only person!) and buy smaller plates to help with portion control. But keep in mind, fixating on weight-loss alone is probably not a healthy approach - instead, focus on nurturing yourself with only the best. You deserve it, and, heck, you're in this for the long-haul. These changes will help protect you from other significant diseases too. Lifting weights, for example, is important since many of the drugs women take after breast cancer can cause osteoporosis, or thinning of your bones. Lifting weights helps combat this. It's never too late to start - exercise and eating well can make a difference, even in the very elderly.

3) Vitamin D? More and more studies are showing a strong connection between low vitamin D, breast cancer and survival - even after diagnosis. In fact, in my opinion, if vitamin D was a patented drug, it would have more ads running continuously than any other pill (and that's saying a lot!). Here's the deal - vitamin D is about the only thing that doesn't just boost your immune system, it also makes it work smarter (a really hard thing to do!). In contrast, indiscriminately boosting your immune system can result in cases where your immune system attacks the wrong thing, or flares in a way that's, frankly, ineffective. But, keep in mind, you CAN overdose on vitamin D - so it's important to know where your body is living, and then optimize it. You want your vitamin D level well into the normal range - luckily, finding out is a simple, easy blood test. Your doctor can help you safely dose up to a good range, then make sure you stay there.

4) Do I have to take pills forever? Here's one of those good new/bad news kind of situations. Women tend to get two very distinct types of breast cancer - those cancers that have a receptor for estrogen, and those that don't. In general, it's much better to get the kind of breast cancer that "feeds" on estrogen. Studies have shown that type of tumor, in large groups of patients, is much more likely to be treatable without recurrence. That's the good news. The "bad" news is that studies also show survival can be definitely improved for groups of patients who take an estrogen-blocking pill for 5 or more years. Even if the tumor comes back! There are now pills that a patient should be taking for ten years after a diagnosis - even if the diagnosis was at age 81! In another of the weird good news/bad news twists, women who get joint pains from taking one of these pills, Femara, are less likely to have the tumor come back (now that's a motivation for enduring some joint pain if there ever was one!).

6) Sleeping, drinking and smoking: The good, the bad and the ugly. Sleep is good for you. While there are no huge, well-designed studies showing a strong link between sleep and disease-free survival from breast cancer, sleep IS associated with a better-functioning immune system, as well as improvement in many other health areas like blood pressure, and diabetes. Many Americans (if not most, in some subgroups) are just not getting enough sleep. Why take the time to make sleep a priority? Sleep is free, has no side-effects, and generally beneficial to your overall health and mood. I believe it's also a marker of other life issues - if you're unable to get enough sleep, there are probably other things impacting your health (like a high-stress life that can result in grab-and-go-bad-food-choices, and a lack of exercise, for example). Alcohol, on the other hand, when it comes to breast cancer, may be bad for you. Most of us have heard that alcohol, in moderation, can be beneficial for some heart disease prevention. [What does "moderation" mean? For women, zero-to-one drinks per night, with a max of less than 7 a week, for sure.] What many of us may not have have heard, however, is that many studies show that alcohol is not good for breast cancer - in fact, the larger the number of alcoholic drinks a week, the worse the risk. If you're living post-breast-cancer diagnosis, when it comes to alcohol, you want to be the picture of moderation. In fact, teetotalling may be the way to go. So if sleep may be the good, and alcohol the bad, smoking is just flat out the ugly. Smoking, and even passive smoke exposure, are associated with breast cancer. Getting a diagnosis can be the wake-up call to help see you through a solid quit. You'll reap mega benefits for ALL your health.

7) Mammograms...what's the point? Once you've been diagnosed with breast cancer, your regular screening becomes even more important. Recurrences can be treated too - and the earlier the better. It's important to not become discouraged (or worse yet, to despair). After the emotional shock of a diagnosis, it can be really hard to remember that finding a cancer is better than NOT finding one (until it's too late...).

So if you know, love, or care about a person who's living with a diagnosis of breast cancer, what can you do to help promote health after treatment is over? Here are some tips - keeping in mind that nagging is never a good way to go, but loving support, and encouragement can make a world of difference!

1) Be eager to move too. Exercise works best when done with a social group, at every age. Take the time to drive grandma to the mall for a gentle stroll each Sunday. Form a lunch-walking or Tai Chi group. Be the person who makes moving fun for those you love! 2) Encourage appropriate testing - mammograms and regular doctor visits (especially waiting for results!) can be grueling rocky experiences without support from those who care. Be aware, and be there, if you care. 3) Help your loved one to remember to ask about a vitamin D test at her next doctor's appointment. Spread the word! 3) Eat well. Just as with exercise, good eating works best when those around you are supportive. Don't be the person who sighs heavily and says, while gazing at the salad, how much nicer some spicy chicken wings would be. But also don't be a criticizer. Mindful nurturing is the way to go when it comes to improving your diet. As Michael Pollan says, "Eat food, not too much. Mostly plants."

What do you think? Got some tips to share for those who care? Post them in the comments section. Get on the Twitter bandwagon and follow Doc Gurley! Also check out Doc Gurley's joyhabit and iwellth twitter feeds - so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your wellth this coming year.



Got a thingie on your doohickey? Or are you pondering how to tell your doctor he's a jerk? Send your burning healthcare questions to Doc Gurley by emailing docgurleyatgmaildotcom. Doc Gurley cannot answer every question, and she cannot practice medicine through a keyboard (not even with her stethoscope pressed firmly against the monitor) but be assured - your questions will be kept strictly confidential and identifying traits are changed.