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'breast cancer' posts

Cardiac risks associated with radiation therapy following breast cancer

Recently, there has been increasing media attention to the risks of heart damage associated with adjuvant breast cancer radiotherapy.

This observation and debate has been ongoing for a long time in medical literature. Most recently, an article in the New England Journal of Medicine concluded that adjuvant radiotherapy for breast cancer increases the rate of ischemic heart disease. The authors conclude that the risk is associated with the dose of radiotherapy to the heart and begins a few years after the treatment. Dr. Kesarwala, an expert radiation oncologist from Bethesda, reviewed the data and provided a report in the April issue of the ACR Journal Advisor. She noted that “nearly 80% of patients in this study had mastectomies and over 90% had adjuvant chemotherapy with regimens very different from those currently used. This study mixed lymph node-positive patients (48%) with lymph node-negative patients, two sub-populations with different expected overall survival who would also have received different types of radiotherapy.” Other variables such as stage, presence of internal mammary nodes, type of surgery, or details of radiotherapy were not matched between the control and treated patients.

Because the study does not provide details regarding the radiotherapy specifically, it is difficult to interpret the conclusions. The doses of radiotherapy delivered ...

Two years in the life of the Swedish blog

For those of you who don't know, today is the official two year anniversary of the Swedish blog - this means Swedish has been blogging several times a week for two full years!

What have we been blogging about this year?

Who's been blogging?

We've had people from across Swedish blogging (more than 100 the last time we checked), including:

  • Surgeons

  • Nurses

  • Family Medicine and Primary Care Physicians

  • Dietitians

  • Educators

  • (And many others!)

Why are we blogging?

We started the blog as a way to connect with you (our community), whether you're a current patient, a past patient, a future patient…or just someone who stumbled across our site looking for health information. We believe our role is to be a resource of information, both online and off. Blogging gives us an easy way to keep you up to date, informed, and engaged on a number of health topics

New Cancer Center to Open April 1 at Swedish/Edmonds; Outpatient Facility to Provide Medical Oncology, Infusion Services Close to Home


 
 


  
Cancer-Center-Opening-2.jpg

Swedish Cancer Institute at Edmonds opens to the public at an April 17 ribbon-cutting ceremony on the Swedish/Edmonds campus. (Left to right) David Loud, aide from Congressman Jim McDermott, M.D.; Swedish Cancer Institute Medical Oncologist Richard McGee, M.D.; Swedish/Edmonds Chief Executive Dave Jaffe; and Swedish Cancer Institute Executive Director Thomas D. Brown, M.D., MBA, cut the ribbon during the event that attracted 250 visitors. The two-story facility, located at 21632 Highway 99 in Edmonds, provides high-quality and comprehensive medical oncology to patients through an infusion unit, laboratory, pharmacy, and access to Swedish’s electronic medical record system.
 
EDMONDS, WASH.
, March 21, 2013 – Swedish Health Services will open a new outpatient cancer center at the Edmonds campus on Monday, April 1, 2013 in response to the growing need for medical oncology and infusion (chemotherapy) services in the south Snohomish and north King County area. The new two-story, 17,102-square-foot facility is anticipated to handle as many as 175 patient visits each day and provide increased access to cancer-care services for people living north of Seattle.

Some challenges in Targeted Therapy

What makes a target? Our understanding of disease is a model, an imagined defect in a fanciful machine. The workings of the intact organism are understood on the basis of the tools at hand and conform to the models of other world events and inventions. In the 19th century, the microscope became a useful tool and the cell was the agent of health and disease. DNA, the agents of heredity, became the basis of the most advanced therapy in the late 20th century. DNA was the target for chemotherapy, as soon as its importance in heredity was realized .

DNA as a target has fallen out of fashion. Now, we imagine the cell as a network of messages, an internet, with signals, noise and switches. These are the modern targets: growth factor receptors (and their mutations), kinases (and their mutations); the cellular equivalents of antennae and amplifiers.

This is the model that is generating today’s medicines (often ...

C4YW Annual Conference For Young Women Affected By Breast Cancer

For the past twelve years, Living Beyond Breast Cancer (LBBC) and Young Survival Coalition (YSC) have been hosting the Annual Conference for Young Women Affected by Breast Cancer, mainly known as C4YW. This year the conference will be held at the Hyatt Regency in Bellevue, Washington, on Seattle’s Eastside! This international conference is dedicated to the issues of young women affected by breast cancer, their family, friends and caregivers.

The Swedish Cancer Institute will have a table at the C4YW event and will have a group of experts to help answer any questions you may have, including:

  • Melissa Kwaterski, Physical Therapist at Swedish Outpatient Physical Therapy will be available to answer questions about rehabilitation and more on Friday, February 22 from 4:30 – 6 p.m.

  • Kathleen Pratt, N.D. from Northwest Natural Health will be answering questions about nutrition, weight loss and weight gain, hormonal changes, and more on Saturday, February 23 from 12 – 2 p.m.
  • Lori Marshall, M.D., from Pacific Northwest Fertility will be answering questions about fertility and infertility including, In-Vitro fertilization, ovulation induction, egg freezing and preservation, and the egg donation program, and more on Saturday, February 23 from 12 – 2 p.m.

Come join us to learn more about resources and services available at the Swedish Cancer Institute, including:

Also, don’t miss out on several opportunities for a chance to go home with a free give-a-way item, like the ‘Imagine’ glassybaby! There will be three ‘Imagine’ glassybaby’s being raffled off, and each of them have proceeds that are dedicated to the Cancer Patient Assistance Fund at the Swedish Cancer Institute. Check out the beautiful color below:

Patient Education Classes at Swedish Cancer Institute

I know how overwhelming it can be when someone is diagnosed with cancer. A wealth of information is presented to you and a lot of it can be hard to remember. Yes, resource packets are wonderful tools and information sheets are extremely useful but sometimes sifting through all of the documents can be cumbersome, especially when you have specific questions. For this reason, the Swedish Cancer Institute (SCI) wants to ensure that you have access to education and information in a way that works for you.

SCI offers education programs to assist you, your family members and your caregivers in making treatment decisions, managing your symptoms, and accessing programs to help your mind, body and spirit to heal.

One of the programs is patient education classes. These classes offer practical tips that you and your family members can take home with you. The classes are intended to complement your treatment here at Swedish but also provide an opportunity where you can ask questions in a safe and secure environment.

Whether you are interested in exploring how the healing powers of art-making can help during your experience with cancer treatment or learning how naturopathic medicine complements conventional cancer treatments (or maybe you want to gain skills and confidence in creating hair alternatives) – whatever the area of focus is, we have classes that fit your needs:

Deciding on surgical treatment for breast cancer

A recent article in the Seattle Times references the 2012 Dartmouth Atlas Report: Improving Patient Decision-Making in Health Care. Unfortunately their take home line, "A new report that found wide geographical variation in the use of elective surgical procedures in Pacific states reflects the preferences of physicians – not what patients want or need, the authors say,” oversimplifies a complicated situation.

On my reading of the report, it stresses the values that an individual woman brings to the decision:

“Different women will prefer one option or the other, depending upon how much they value preserving their breast, their willingness to undergo radiation or more invasive surgery, and the level of uncertainty they are willing to live with in terms of their cancer recurring.”

As a breast surgeon who has practiced in Seattle for almost 40 years, I don’t believe that “the preferences of physicians” are the driving factor. I have a few observations to make.

It is clear that wide variations in treatment of early stage breast cancer can be seen across the USA, as the Dartmouth-Atlas data confirms. Some factors that influence this are physician related – for example, what % of their surgical practice involves treating women with breast cancer. Specialists in breast cancer or general surgeons who treat large numbers of women with breast cancer are motivated to be current in their practice patterns and to make sure that their patients are making considered decisions. The utilization of breast MRI has been shown to influence the mastectomy rates and there is regional variation in the use of that study. Distance to a radiation oncology treatment center is a factor for some women as are potential differences in out of pocket costs between mastectomy and breast conservation.

All of the local breast surgeons that I know strongly value shared decision making with their patients. We all work hard to present treatment options fairly and as neutrally as possible. If we have a patient that we think is choosing mastectomy over breast conservation out of fear – for example, fear of radiation therapy – we will encourage her to consult with a radiation oncology specialist prior to making a final decision. We believe that one of our roles is to help our patients make informed decisions. If there are clear medical reasons why one treatment is preferred, we will state that but otherwise encourage the patient to make the best decision for herself.

For example...

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