Previously, I have reported on studies that regular exercise may play an important role in prevention of depression among breast cancer survivors. (For more details, read “Lifestyle Makes a Difference in Combating Depression After Breast Cancer“). There is also a growing body of scientific evidence links the risk of developing a first breast cancer or recurrent breast cancer with such lifestyle factors as weight, physical activity, and alcohol use. As this video above from the Dana-Farber Cancer Institute in Boston shows, as little as 30 minutes per day of regular exercise, such as walking, can help you reduce your risk of breast cancer.

Overweight and obese postmenopausal women have been shown to be up to twice as likely to develop breast cancer as women of normal weight. Higher rates of breast cancer have also been associated with an inactive lifestyle and consumption of more than seven drinks of alcohol per week for women.

Furthermore, obese women who lead a sedentary life have an increased risk of breast cancer recurrence. One study showed that women who were overweight at the time of their initial diagnosis were 50% more likely to get a second breast cancer compared with women who were not overweight. Women who consumed more than seven drinks a week after their first breast cancer diagnosis were found to have a 70% increased risk of developing cancer in the opposite breast when compared with nondrinkers.

There are, however, some health benefits to moderate drinking — one drink or less per day for women and two drinks or less for men, especially of red wine — such as lowering the risk of heart disease. In addition, if you are receiving chemotherapy, your nutritional needs change and it’s not a good idea to go on a low-calorie diet because you need to add calories and protein to your diet to help you fight infections and boost your energy.

For more information about good nutrition and regular exercise from our companion website, go to this link patientresource.net

References:
1. Nagaiah G, Hazard HW, Abraham J: Role of obesity and exercise in breast cancer survivors. Oncology 2010;24:342-346.
2. McCarthy AM, Visvanathan K: Breast cancer prognosis: weighing the evidence on weight and physical activity. Oncology 2010;24:342-346.
3. Ligibel JA: Could modification of lifestyle factors prevent second primary breast cancers? Journal of Clinical Oncology 2009;27(32):5301-5302.
4. Li CI, Daling JR, Porter PL, et al: Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer. Journal of Clinical Oncology 2009;27:5312-5318.

Expert Analysis Highlights:

• This video provides patients with the chance to see what actually happens during the course of radiation treatment
• On a daily bases there is no pain or discomfort with the treatment
• Treatment course can extend anywhere from 2-8 weeks
• Side effects are highly dependent on the region of the body being treated and the total dose

Radiation treatments are used in the majority of patients with cancer, and yet most patients have little idea of what to expect. This video is helpful in showing what happens during the course of a single radiation treatment. Some take home messages include that the technology has become relatively sophisticated, that the treatment has to be precisely delivered to one defined area of the body, and that on a daily bases there is no pain or discomfort with the treatment.

Prior to this patient’s treatments, a series of events had already taken place. You can see in the video that the patient’s head is immobilized by plastic mask that is fastened onto the table. The purpose of this and other forms of immobilization is to assure that the carefully planned treatment is able to be reproduced each day when the patient comes for their daily treatment. Treatment course can extend anywhere from 2-8 weeks and the ability of the treatment to hit its target is highly dependent on the ability to precisely reproduce the position of the patient each day. Also prior to the treatment, a CAT scan of the patient while he was immobilized in his mask was obtained. This information is transferred to treatment planning computers and the doctor outlines the targeted region and the normal tissues to avoid. Working with his team, the doctor then helps determine the optimal angle of beam entrance and exit and the shape and intensity of each field. In the video, four fields were used: one from the front, one from the back and one from each side. These four beams will have a mutual intersection point at the targeted region where the addition from each beam will result in a selectively high dose to this region. Within the treatment head of the machine are a collimation system that can shape the beam edges into almost any shape which further adds to the precision of the dose delivery.

Radiation treatments are a scary endeavor for any patient and the treatment can cause some side effects that are highly dependent on the region of the body being treated and the total dose. What I liked about the video is that it provides patients with the chance to see what actually happens within the treatment room. In doing so, I hope you were left with the impression that it’s not that bad and when it is warranted it can provide a great service to cancer patients.

There are many options for breast reconstructive surgery. One of the more popular is the TRAM flap, especially for a woman with excess belly fat or an abdomen that has been stretched out by pregnancy. You end up with a “tummy tuck”; as a fringe benefit of surgery. I like this video because it shows some nice anatomical drawings that explain the operation.

At many Breast Centers, including our own at Johns Hopkins, the TRAM flap has been replaced by the DIEP flap of abdominal tissue. This has the advantage of not taking any of the rectus abdominal muscle and thus decreases the risk of abdominal weakness or hernias.

Here’s more information from patientresource.net:

Breast reconstructive surgery is done by an experienced plastic surgeon. This surgery is usually done at the time of total mastectomy or later (within months after mastectomy).

Immediate reconstruction can be done for early-stage (stage I or some stage II) breast cnacers, but it is usually best to wait for reconstruction if the breast cancer is more advanced (stage III or some stage II). Increasingly, a “skin-sparing mastectomy” and temporary breast implants are used as the initial process of breast reconstructive surgery, with the final stages of reconstruction performed after all the cancer treatments are completed. If you are to have a mastectomy and think you will want reconstructive surgery, it is best to discuss your choice with your cancer surgeon and a plastic surgeon before the mastectomy so they can properly plan your treatment, even if the reconstructive surgery will not be done until later.

Reconstructive surgery cannot be done for all types of breast cancer. Women who do not want or cannot have reconstructive surgery can be fitted with a breast prosthesis. This prosthesis is a breast form (made of artificial materials) that you put in your bra to make your breast look natural and balanced.

For women who are considering surgery for breast cancer, this is a nice video showing anatomy of the breast and lymph glands in the armpit as well as basic elements of breast cancer surgery. Here’s more information from our companion website, patientresource.net:

The two types of surgery used for primary treatment of breast cancer are a partial mastectomy (lumpectomy) and a total or complete mastectomy. With either of these procedures, lymph nodes under the arm (axillary nodes) are removed for biopsy and more are removed if there is documented spread to these nodes. In addition, reconstructive surgery may be done to rebuild the breast to look similar to its preoperative appearance. Other surgery that may be considered is a prophylactic (preventive) mastectomy of the opposite breast in limited circumstances.

It is important to note that both types of surgery are associated with similar long-term survival, but each one has its unique set of side effects and complications. Because of this, a woman’s perspective on quality of life is an important consideration in deciding which surgery to have.

Of all the videos about robotic surgery for prostate cancer, this is one of the most detailed and informative for patients. It shows the operation from beginning to end. The robotic-Assisted Laparoscopic Prostatectomy was performed by Robert P. Caruso, M.D. Director of Laparoscopic and Robotic-Assisted Surgery at Essex-Hudson Urology in Bloomfield, NJ.

Here is a nice clip from the UK for women that has some practical advice about sexual issues after cancer treatments. You should talk with your doctor before treatment begins to find out what to expect in terms of sexuality issues. If there are treatment options, make sure to talk about the side effects of each option. Ask your doctor when it is safe to resume sexual activity after treatment. During and after treatment, talk to your doctor or nurse if you have symptoms that interfere with sexual desire or sexual performance. If you feel uncomfortable talking with your doctor or nurse about your sexual symptoms, ask for a referral to an appropriate health care professional or support group.

Here’s more information from our companion website, patientresource.net:

There are a wide range of reasons for changes in sexuality during cancer treatment, and the reasons relate to the treatments themselves as well as to other side effects of treatment.

Surgery has a variety of effects on sexuality. Removal of all or part of a reproductive organ decreases hormone levels, which can lead to overall loss of sexual desire. Such surgery can lead to premature menopause in younger women, and may make sexual intercourse painful or difficult for younger and older women. Surgery in the pelvic area in men can damage the nerves leading to the penis, causing erectile dysfunction. Lastly, surgery that changes body appearance, as with removal of a breast or a testicle, can affect how a person feels about his or her body image. A negative body image can change how you feel about your sexual desirability.

Chemotherapy or radiation therapy to the pelvis may damage the ovaries in women or the testicles in men, both of which can reduce the amount of hormones produced. This loss of hormones may cause a loss of sexual desire in men and women, premature menopause in younger women, and erectile dysfunction in men.

The side effects of cancer treatments also play an important role in sexuality. Side effects such as fatigue, nausea and vomiting, pain, diarrhea, and mouth sores can substantially reduce a person’s interest in sex and his or her feelings of desirability.

Some treatments are available for physical sexual issues. For example, vaginal dryness can be treated with vaginal moisturizers and lubricants. Several drugs are available for erectile dysfunction, including sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs may not be appropriate for every man, and men should talk to their doctors about the risks and benefits. Hot flashes in both women and men have been relieved with low doses of antidepressants such as fluoxetine (Prozac), venlafaxine (Effexor), duloxetine (Cymbalta), and paroxetine (Paxil). Management of side effects that interfere with intimacy can help you feel better overall, which may help you feel more desirable and more interested in sex.

Open communication with your spouse or significant other is key to maintaining a good intimate relationship. You and your partner should share concerns and fears. Talk about ways to be intimate other than with sexual intercourse. You should both understand that it is safe to have sex during cancer treatment (unless your doctor tells you otherwise). Counseling (individual, couples, and/or sex therapy) may be helpful.