Wednesday, June 21, 2017

What to Do After a Breast Cancer Diagnosis

Experts explain what newly diagnosed cancer patients need to know to help fight their disease.

FROM THE WEBMD ARCHIVES

Approximately one out of every two American men and one out of every three American women will have some type of cancer at some point during their lifetime, according to the American Cancer Society.

This year almost 1.4 million Americans will hear the words "You've got cancer," and in that instant their lives will be forever transformed.

Bianca Kennedy heard them five years ago, and, like most people, her initial emotion was shock, followed by the question, "Am I going to die?"

Kennedy, now 40, was diagnosed with early breast cancer when her then 38-year-old sister was battling the disease for the third time.

"My sister was grossly undertreated the first two times, and I learned from her experience," Kennedy tells WebMD. "When I was diagnosed I didn't agonize about how aggressively to treat my cancer because I had seen what she what she went through."

What Should You Do?

Kennedy ended up having both breasts removed, followed by chemotherapy and breast reconstruction. She now counsels newly diagnosed patients as a volunteer for Y-ME, a 24-hour support hot line staffed entirely by breast cancer survivors.

She knows firsthand the importance of being an involved, educated patient, but she says most people need time to come to terms with their diagnosis.

"It is common for people who have just been diagnosed to be overwhelmed with all the information they are getting and the choices they are being asked to make," she says. "You are bombarded with facts and figures and statistics, and it is really hard to keep a cool head. But the choices you make are critical and they may impact the rest of your life."

So what are the most important things newly diagnosed patients can do to maximize their odds of beating cancer? WebMD posed this question to doctors, patient advocates, and cancer survivors, and some common themes emerged. They included:

Get the Facts

Everyone interviewed for this story agreed that education is critical. That means learning all you can about the specifics of you own cancer and how to best treat it. This is especially important for diseases like breast cancer and lymphoma, where treatments vary greatly.

"I have seen people waste a lot of precious time researching the wrong thing because they didn't really understand their cancer," says Joan Arnim, who manages the patient advocacy program at Houston's M.D. Anderson Cancer Center. "It is often a good idea to ask your doctor for recommendations about where to get information about your particular cancer."

Know Your Information 'Comfort Level'

While some patients go into overdrive learning all they can almost immediately, others either don't feel comfortable doing this or don't want to know too many specifics.

Internet-savvy family members or friends can be called on when patients can't do their own research.

M.D. Anderson gynecological cancer specialist Charles Levenback, MD, tells WebMD that it is important that patients think about just how much information they want before they sit down with their doctors.

"These days the assumption is that the patient wants to know everything, but some may really only want the big picture," he says. "Or they want more information as time goes on. It is important to communicate this."

It is also a good idea to write down questions before meeting with your doctor. The American Cancer Society web site includes a long list of potential questions which can be found in the "Learn about Cancer" section of the site, under the main heading "Patients, Family and Friends." Sample questions, which can be printed and taken along on doctors visits, can also be found on WebMD.

Another Set of Ears

Patients often benefit when they bring someone along to appointments for support and to act as another set of ears, Levenback says. A friend is often better than a close family member in this support role, because family members are often as upset as the patient.

Christina Koenig of Y-ME recommends bringing a tape recorder to doctor's appointments if all agree that this is appropriate.

At the very least, someone should take notes during appointments, Arnim says.

"I've had people tell me that after the first five minutes they didn't hear a thing their doctor was telling them," she says. "That is to be expected"

Don't Be Afraid to Rock the Boat

Arnim says cancer patients are often reluctant to speak up when they are upset about something, out of a conscious or subconscious fear that their doctors or other medical caregivers will abandon them.

"The tendency when someone is feeling vulnerable and scared is to put up with something rather than rock the boat," she says. "But even though your instincts may be telling you to keep quiet, it is important to speak up."

Rocking the boat also means not accepting everything your doctors tells you as gospel. If you feel the need for a second or even third opinion on any aspect of your cancer care, get one.

This advice is equally true for people who suspect they have cancer or some other serious problem, but have been told nothing is wrong, Kennedy says.

"If a doctor is dismissive or hard to communicate with, or tells you nothing is wrong when your gut tells you it is, you need to find another doctor," she says.

Forty-seven-year-old Julie Gomez learned this lesson the hard way. The Houston woman saw a long line of doctors for a painful stomach problem for almost a decade before her rare gastrointestinal cancer was finally diagnosed.

"I was told I had acid reflux or that I ate too fast," she says. "One doctor did all the right tests, and actually saw something on the scan but told me he just didn't believe it. That was eight years before I was finally diagnosed."

Talk to Other Patients

Gomez has had four surgeries to remove gastrointestinal tumors in the 10 years since her cancer was diagnosed, and she may face more in the future if the tumors target her liver or grow big enough to block her intestines.

She now volunteers at a telephone hot line run by M.D. Anderson that matches cancer patients with people who have had the same diagnosis or treatment.

"My cancer is so rare that I didn't meet another person who had it until five years after my diagnosis," she says. "It was very, very lonely."

Gomez now talks to at least one person a week with her disease in her volunteer role, and she believes this is one of the best things patients can do to learn about their illness.

"The Internet is a great learning tool, but it can also scare you to death," she says. "The statistics, especially, can be misleading. They may tell you survival for your disease is less than five years, for example, but if most people with your cancer are diagnosed in the 60s and 70s and you are in your 30s, that may not apply to you."

Tools You Can Use

The M.D. Anderson hot line can be reached by calling (800) 345-6324. All cancer patients or their caregivers are eligible to call. The Y-ME breast cancer support hot line can be reached in English at (800) 221-2141 and in Spanish at (800) 986-9505. Interpreters are also available in 150 other languages.

The American Cancer Society (www.cancer.org) and the National Cancer Institute (www.cancer.gov) both operate comprehensive web sites that include information on cancer treatments and clinical trials, as does WebMD. The information hot line number for ACS is (800) ACS-2345 and the number for NCI is (800) 4-CANCER.

The ACS offers a service to patients and their families that will help match them with clinical trials in their area. To find out about this service call (800) 303-5691 or click on the section entitled Emerging Medical Clinical Trials Matching Service on the ACS web site. You can find out about cancer trials through the NCI at the web site www.clinicaltrials.gov.

The ACS web site also offers a service to help patients understand their treatment options, says spokesman David Sampson. To access the service click on "Using Treatment Decision Tools" on the group's home page.

New Hats and Turbans for summer...

New hat and turban summer fashions just arrived. Perfect for sun protection and wearing around the house or on errands. We look forward to seeing you.

Saturday, June 3, 2017

In Search of DNA Connectivity: How Neanderthals Gave Us Secret Powers

How Neanderthals Gave Us Secret Powers

Interbreeding with our fellow hominins appears to have helped humans survive harsh climates.

Native Tibetans make use of a gene derived from Denisovans to stay healthy at high altitudes.Nicolás Marino / Quanta

Early human history was a promiscuous affair. As modern humans began to spread out of Africa roughly 50,000 years ago, they encountered other species that looked remarkably like them—the Neanderthals and Denisovans, two groups of archaic humans that shared an ancestor with us roughly 600,000 years earlier. This motley mix of humans coexisted in Europe for at least 2,500 years, and we now know that they interbred, leaving a lasting legacy in our DNA. The DNA of non-Africans is made up of roughly 1 to 2 percent Neanderthal DNA, and some Asian and Oceanic island populations have as much as 6 percent Denisovan DNA.
Over the last few years, scientists have dug deeper into the Neanderthal and Denisovan sections of our genomes and come to a surprising conclusion. Certain Neanderthal and Denisovan genes seem to have swept through the modern human population—one variant, for example, is present in 70 percent of Europeans—suggesting that these genes brought great advantage to their bearers and spread rapidly.
“In some spots of our genome, we are more Neanderthal than human,” said Joshua Akey, a geneticist at the University of Washington. “It seems pretty clear that at least some of the sequences we inherited from archaic hominins were adaptive, that they helped us survive and reproduce.”

But what, exactly, do these fragments of Neanderthal and Denisovan DNA do? What survival advantage did they confer on our ancestors? Scientists are starting to pick up hints. Some of these genes are tied to our immune system, to our skin and hair, and perhaps to our metabolism and tolerance for cold weather, all of which might have helped emigrating humans survive in new lands.
“What allowed us to survive came from other species,” said Rasmus Nielsen, an evolutionary biologist at the University of California, Berkeley. “It’s not just noise, it’s a very important substantial part of who we are.”

*Illustration by Lucy Reading-Ikkanda for Quanta Magazine, based on a map by Sriram Sankararaman.*

* * *

The Tibetan plateau is a vast stretch of high-altitude real estate isolated by massive mountain ranges. The scant oxygen at 14,000 feet—roughly 40 percent lower than the concentrations at sea level—makes it a harsh environment. People who move there suffer higher rates of miscarriage, blood clots, and stroke on account of the extra red blood cells their bodies produce to feed oxygen-starved tissue. Native Tibetans, however, manage just fine. Despite the meager air, they don’t make as many red blood cells as the rest of us would at those altitudes, which helps to protect their health.
In 2010, scientists discovered that Tibetans owe their tolerance of low oxygen levels in part to an unusual variant in a gene known as EPAS1. About 90 percent of the Tibetan population and a smattering of Han Chinese (who share a recent ancestor with Tibetans) carry the high-altitude variant. But it’s completely absent from a database of 1,000 human genomes from other populations.
In 2014, Nielsen and colleagues found that Tibetans or their ancestors likely acquired the unusual DNA sequence from Denisovans, a group of early humans first described in 2010 that are more closely related to Neanderthals than to us. The unique gene then flourished in those who lived at high altitudes and faded away in descendants who colonized less harsh environments. “That’s one of the most clear-cut examples of how [interbreeding] can lead to adaptation,” said Sriram Sankararaman, a geneticist and computer scientist at the University of California, Los Angeles.

The idea that closely related species can benefit from interbreeding, known in evolutionary terms as adaptive introgression, is not a new one. As a species expands into a new territory, it grapples with a whole new set of challenges—different climate, food, predators, and pathogens. Species can adapt through traditional natural selection, in which spontaneous mutations that happen to be helpful gradually spread through the population. But such mutations strike rarely, making it a very slow process. A more expedient option is to mate with species that have already adapted to the region and co-opt some of their helpful DNA. (Species are traditionally defined by their inability to mate with one another, but closely related species often interbreed.)
This phenomenon has been well documented in a number of species, including mice that adopted other species’ tolerance to pesticides and butterflies that appropriated other species’ wing patterning. But it was difficult to study adaptive introgression in humans until the first Neanderthal genome was sequenced in 2010, providing scientists with hominin DNA to compare to our own.
Neanderthals and Denisovans would have been a good source of helpful DNA for our ancestors. They had lived in Europe and Asia for hundreds of thousands of years—enough time to adjust to the cold climate, weak sun and local microbes. “What better way to quickly adapt than to pick up a gene variant from a population that had probably already been there for 300,000 years?” Akey said. Indeed, the Neanderthal and Denisovan genes with the greatest signs of selection in the modern human genome “largely have to do with how humans interact with the environment,” he said.

To find these adaptive segments, scientists search the genomes of contemporary humans for regions of archaic DNA that are either more common or longer than expected. Over time, useless pieces of Neanderthal DNA—those that don’t help the carrier—are likely to be lost. And long sections of archaic DNA are likely to be split into smaller segments unless there is selective pressure to keep them intact.

In 2014, two groups, one led by Akey and the other by David Reich, a geneticist at Harvard Medical School, independently published genetic maps that charted where in our genomes Neanderthal DNA is most likely to be found. To Akey’s surprise, both maps found that the most common adaptive Neanderthal-derived genes are those linked to skin and hair growth. One of the most striking examples is a gene called BNC2, which is linked to skin pigmentation and freckling in Europeans. Nearly 70 percent of Europeans carry the Neanderthal version.
Scientists surmise that BNC2 and other skin genes helped modern humans adapt to northern climates, but it’s not clear exactly how. Skin can have many functions, any one of which might have been helpful. “Maybe skin pigmentation, or wound healing, or pathogen defense, or how much water loss you have in an environment, making you more or less susceptible to dehydration,” Akey said. “So many potential things could be driving this—we don’t know what differences were most important.”

* * *

One of the deadliest foes that modern humans had to fight as they ventured into new territories was also the smallest—novel infectious diseases for which they had no immunity. “Pathogens are one of the strongest selective forces out there,” said Janet Kelso, a bioinformatician at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.
Earlier this year, Kelso and collaborators identified a large stretch of Neanderthal DNA—143,000 DNA base-pairs long—that may have played a key role in helping modern humans fight off disease. The region spans three different genes that are part of the innate immune system, a molecular surveillance system that forms the first line of defense against pathogens. These genes produce proteins called toll-like receptors, which help immune cells detect foreign invaders and trigger the immune system to attack.

Modern humans can have several different versions of this stretch of DNA. But at least three of the variants appear to have come from archaic humans—two from Neanderthals and one from Denisovans. To figure out what those variants do, Kelso’s team scoured public databases housing reams of genomic and health data. They found that people carrying one of the Neanderthal variants are less likely to be infected with H. pylori, a microbe that causes ulcers, but more likely to suffer from common allergies such as hay fever.
Kelso speculates that this variant might have boosted early humans’ resistance to different kinds of bacteria. That would have helped modern humans as they colonized new territories. Yet this added resistance came at a price. “The trade-off for that was a more sensitive immune system that was more sensitive to nonpathogenic allergens,” said Kelso. But she was careful to point out that this is just a theory. “At this point, we can hypothesize a lot, but we don’t know exactly how this is working.”
Most of the Neanderthal and Denisovan genes found in the modern genome are more mysterious. Scientists have only a vague idea of what these genes do, let alone how the Neanderthal or Denisovan version might have helped our ancestors. “It’s important to understand the biology of these genes better, to understand what selective pressures were driving the changes we see in present-day populations,” Akey said.

A number of studies like Kelso’s are now under way, trying to link Neanderthal and Denisovan variants frequently found in contemporary humans with specific traits, such as body-fat distribution, metabolism or other factors. One study of roughly 28,000 people of European descent, published in Science in February, matched archaic gene variants with data from electronic health records. Overall, Neanderthal variants are linked to higher risk of neurological and psychiatric disorders and lower risk of digestive problems. (That study didn’t focus on adaptive DNA, so it’s unclear how the segments of archaic DNA that show signs of selection affect us today.)

At present, much of the data available for such studies is weighted toward medical problems—most of these databases were designed to find genes linked to diseases such as diabetes or schizophrenia. But a few, such as the U.K. Biobank, are much broader, storing information on participants’ vision, cognitive test scores, mental health assessments, lung capacity and fitness. Direct-to-consumer genetics companies also have large, diverse data sets. For example, 23andMe analyzes users’ genetics for clues about ancestry, health risk and other sometimes bizarre traits, such as whether they have a sweet tooth or a unibrow.

Of course, not all the DNA we got from Neanderthals and Denisovans was good. The majority was probably detrimental. Indeed, we tend to have less Neanderthal DNA near genes, suggesting that it was weeded out by natural selection over time. Researchers are very interested in these parts of our genomes where archaic DNA is conspicuously absent. “There are some really big places in the genome with no Neanderthal or Denisovan ancestry as far as we can see—some process is purging the archaic material from these regions,” Sankararaman said. “Perhaps they are functionally important for modern humans.”

This post appears courtesy of Quanta Magazine.

https://www.theatlantic.com/science/archive/2016/05/how-neanderthal-dna-helped-humans-survive/484934/

Thursday, June 1, 2017

Cancer treatment myths: Any truth to these common beliefs?

Misconceptions about cancer treatment might make you feel confused or unsure when choosing a treatment. Learn the truth so that you can feel more comfortable with your cancer treatment.

By Mayo Clinic Staff

Timothy Moynihan, M.D.

As advances in the treatment of cancer have increased, you may have discovered more opportunities to learn the facts about this disease. Yet some misleading ideas about cancer treatment still persist.

Timothy J. Moynihan, M.D., a cancer specialist at Mayo Clinic, Rochester, Minnesota, helps debunk some of the most common misconceptions about cancer treatment and explains the truth.

Myth: A positive attitude is all you need to beat cancer

Truth: There's no scientific proof that a positive attitude gives you an advantage in cancer treatment or improves your chance of being cured.

What a positive attitude can do is improve the quality of your life during cancer treatment and beyond. You may be more likely to stay active, maintain ties to family and friends, and continue social activities. In turn, this may enhance your feeling of well-being and help you find the strength to deal with your cancer.

Myth: If we can put a man on the moon, we should have cured cancer by now

Truth: Finding the cure for cancer is proving to be more complex than mastering the engineering and physics required for spaceflight.

Cancer actually includes a large group of diseases. Each can have many different causes. Despite advances in diagnosis and treatment, doctors still have much to learn about what triggers a cell to become cancerous and why some people with cancer do better than others.

In addition, cancer is a moving target. Cancer cells may continue to mutate and change during the course of the disease. This may lead to the cancer cells no longer responding to the chemotherapy drugs or radiation treatments that were given initially.

Myth: Drug companies and the Food and Drug Administration (FDA) are blocking or withholding new cancer treatments

Truth: Your doctor and the FDA, which must approve new drugs before they can be marketed, are your allies. As such, they make your safety a high priority.

Unfortunately, scientific studies to determine the safety and effectiveness of new cancer treatments take time. That may create the appearance or lead to reports that effective new treatments are being blocked.

If you still believe a cure is being purposefully withheld, ask yourself why a doctor would choose to specialize in cancer research. Doctors often go into cancer research because they have a family member or friend affected by the disease.

Doctors are as interested in finding a cure as anyone else, for the same reason — it affects them personally. They hate to see a loved one in pain and don't wish to lose this person. They also want to spare others what they have gone through.

Myth: Regular checkups and today's medical technology can detect all cancer early

Truth: Although regular medical care can indeed increase the ability to detect cancer early, it can't guarantee it. Cancer is a complicated disease, and there's no sure way to always spot it.

Routine screening has been linked to a decrease in deaths from cancers of the cervix, breast, lung, colon and rectum.

Myth: Undergoing cancer treatment means you can't live at home, work or go about your usual activities

Truth: Most people with cancer are treated on an outpatient basis in their home communities.

At times it may be helpful to travel to a specialty medical center for treatment. But often, doctors at such a medical center can work with doctors in your hometown so that you can be with your family and friends and perhaps even resume work.

A lot of research has gone into making it easier for people to live more-normal lives during their cancer treatment. For example, drugs are now available to help better control nausea. The result is you're often able to work and stay active during your treatment.

Myth: Cancer is always painful

Truth: Some cancers never cause pain.

For people who do experience cancer pain, especially people with advanced cancer, doctors have become more aware of the need to control such pain and have learned better ways to manage it. Although all pain may not be eliminated, it may be controlled so that it has little impact on your daily routine.

Myth: A needle biopsy can disturb cancer cells, causing them to travel to other parts of the body

Truth: For most types of cancer, there's no conclusive evidence that a needle biopsy — a procedure used to diagnose many types of cancer — causes cancer cells to spread.

There are exceptions, though, of which doctors and surgeons are aware. For instance, a needle biopsy usually isn't used in diagnosing testicular cancer. Instead, if a doctor suspects testicular cancer, the testicle is removed.

Myth: Surgery causes cancer to spread

Truth: Surgery can't cause cancer to spread. Don't delay or refuse treatment because of this myth. Surgically removing cancer is often the first and most important treatment.

Some people may believe this myth because they feel worse during recovery than they did before surgery. And if your surgeon discovers during surgery that your cancer is more advanced than first thought, you may believe the surgery caused more extensive cancer. But there is no evidence to support this.

Myth: Everyone with the same kind of cancer gets the same kind of treatment

Truth: Your doctor tailors your treatment to you. What treatment you receive depends on where your cancer is, whether or how much it has spread, and how it's affecting your body functions and your general health.

More and more, cancer treatment is being tailored based on your genes. These genes, which you're born with, may show that your body processes certain chemotherapy treatments and drugs differently than someone else's body. Genetic testing on your cancer cells can also help guide your treatment.

Myth: Everyone who has cancer has to have treatment

Truth: It's up to you whether you want to treat your cancer. You can decide this after consulting with your doctor and learning about your options.

A person with cancer might choose to forgo treatment if he or she has:

A slow-growing cancer. Some people with cancer might not have any signs or symptoms. Lab tests might reveal that the cancer is growing very slowly. These people might choose to wait and watch the cancer. If it suddenly begins growing more quickly, treatment is always an option.
Other medical conditions. If you have other significant illnesses, you may choose not to treat your cancer, as the cancer may not be the biggest threat to your health. This may be especially true in the case of a slow-growing cancer.
A late-stage cancer. If the burden of treatment side effects outweighs the benefit that treatment can bring, you might choose not to be treated. But that doesn't mean your doctor will abandon you. Your doctor can still provide comfort measures, such as pain relief

http://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer/art-20046762/?utm_source=newsletter&utm_medium=email&utm_campaign=living-with-cancer&pg=2