I'm Had Enough: Half of BC Survivors Stop Tamoxifen Early

This is a headline that quadruples my empathy factor:  "Half of breast cancer patients stop taking hormone drugs."
      I've been there.  I did that.
      And damn, I'm here to tell you about it.
      But first, here's what was reported, from USA Today by Liz Szabo Half of breast cancer patients stop taking hormone drugs and from the American Society of Clinical Oncology Fewer than half of breast cancer survivors adhere....  from a study of 8800 women with early-stage breast cancer.  Researchers found that only 49 percent of the women completed the recommended regimen for tamoxifen, aromatase inhibitors or both.
      It boggles my mind.  Less than 50 percent of women took a proven treatment that cuts the risk of recurrence in half.
     The findings resulted from an analysis of automated pharmacy records of women with hormone sensitive breast cancer, Stages I - III.  What's especially troubling is the group with the lowest adherence rate was in the group of women under 40.
     We need to have some serious conversation here.
     One of the physicians quoted in the article pinpointed to me the huge disconnect between pharma, epidemiology, oncologists and survivors.
     "We were surprised to see that so many young women stopped treatment early..." said Dawn Hershman, MD, associate professor of medicine and epidemiology at Columbia University Medical Center, who led the study.  "Perhaps we need to do a better job of making patients aware that to get the full benefit of treatment they need to take their medications on time and for the full duration."
      Yes.  That's a problem.  Breast cancer treatment (and other cancers, of course, the breasts don't own everything) is like running consecutive marathons.  In my case marathon one:  FAC.  Marathon two: a string of surgeries.  Marathon three:  Taxotere.  Marathon four:  radiation.  Marathon five: tamoxifen.  The first four marathons are time limited.  You're going to recover from a surgery.  The effects of chemo wane until you go in for the next dose.  Then you repeat the cycles until all the doses have been received.  Radiation is x-number of days.
      But tamoxifen lasts for five years and its effects, especially on younger, premenopausal women can be and are often severe.  For the clinician side effects are lists of words on paper.  For survivors side effects mean that the thinking disarray, exploding hot flashes, joint pain and swelling make living and working very, very difficult.
      I remember sitting in my office many days wondering if my mind would ever process information efficiently again or what life would be like without hot flashes that started somewhere near my belly button and burned all the way up through my abdomen and thorax before exiting my head until it felt like every artery was about to explode.  Only a caricature image of my head with steam coming out my ears helped me cut through the discomfort.
      So after three years, with the agreement of my oncologist,  I stopped taking Tamoxifen.  He told me that the first three years following diagnosis are critical.  I made it through those three years.  I had already started intense exercise to combat symptoms of menopause and I continue to this day.  Some hot flashes still manage to squeak through.  I'm still hot most of the time.  But my thinking did not completely clear until I stopped Tamoxifen. I was so, so glad to have me back.
       The point of intervention:  let's find better ways to help young women cope other than lip service.  Let's stop denying that Tamoxifen is such a difficult drug to take, and let's get some alternatives working.  If lumpectomy and radiation are effective cures, and a woman's "recurrence rate" is say, 10%, can she take survivorship head on and manage that risk with lifestyle interventions and diet?  Doesn't that "prescription" reduce recurrence rate as well?  What if the woman is 39?  And her neighbor 59?
        I'm left with as many questions as ever:  who is following the women who did not take tamoxifen?  Will we ever know how they fared?  Do we want to know?  My cancer was such that I left no stone unturned.  But this report tells us that the case is otherwise for many, many women.
       How do you respond to a friend who skips this treatment?  

Poverty As Carcinogen

Proboscis Monkey.  He has enough to eat.
25% of America's children don't.

Last night my sister and I added another narrative layer to our lives -- we started to text each other while watching NATURE on PBS, she from her living room across town, I from mine. 
        The particular episode that sent us into into peals of laughter was the "World's Ugliest Animals," of which the unusually endowed proboscis monkey (left) was one example. Our goofy texting and commentary was in stark relief to this earlier exchange of messages:   


        R u watching 60 Minutes?
        Yes.  Crying
        Me too
        God.
        Feel so selfish.
        I know.  I felt the same way. And I keep thinking about all those wall st. types with all their billions and I think, really?  It wouldn't take so much would it?
        No. The change on their bureau would do.

        We were talking about a Scott Pelley's story about a country where almost 25% of the children are in poverty. That country is America.
        To add to the irony, or more accurately, the heartbreak, Pelley's interviews were conducted in Seminole County, Florida, adjacent to the 25,000 acres Walt Disney World occupies. Even Dickens couldn't have cooked that one up.
        The social and ethical ramifications of hungry, homeless children is enough to take in.  But there's more. There's always more.
        More than twenty years ago, Samuel Broder, MD, one of the physicians who developed some of the first effective AIDS treatements (AZT) and former head of the National Cancer Institute, said, "Poverty is a carcinogen."  This was pointed out in a moving and powerful post by J. Leonard Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society and known simply as @DrLen. 
        Yes, being poor, hungry, un- or undereducated puts one at significant risk for cancer. While the largely well-educated (yes, WASPS like me) professional classes can afford the luxury of debating whether drinking out of a styrofoam cup or using cosmetics will up my risk for cancer - we are simultaneously living in a society where the largest number of children since the Great Depression are growing up hungry; many homeless.  There are some things the greatest cancer advances ever imagined can never fix, and this is one of them. Only we can help fix this, by advocating for not just equitable health care, but a more equitable society where children don't have to worry that they are costing their parents too much money, or about not wanting their friends to know that their father stood on the street corner holding a sign.
        Cancer is social. Cancer is economic.  Cancer is political.
        As Dr. Len wrote,  "If we are serious about reducing the burden and suffering from cancer, why aren't we paying attention to those most in need?"
        Why indeed.  Last night these two separate stories -- the 60 Minutes feature and Dr. Len's blog -- ran through my thoughts and eventually had a head-on collision.  
         And I can't let it go.  

Science of Cancer Survivorship Research Growing

Since my cancer diagnosis in l998 there has been an explosion in survivorship advocacy, research and information for the 11, oops, now 12 million cancer survivors in America - - a number that has tripled during the past thirty years according to a Lance Armstrong Foundation report.

The emerging field of cancer survivorship research underscores what we as survivors can do to enhance our lives and how cancer professionals can help guide that path.

Last week the fifth Cancer Survivorship Research Conference convened  in Washington DC  for two and a half days’ of presentations  on cancer rehabilitation, physical activity and survivorship, survivorship in women of color,  issues for young cancer survivors, and the perception of both benefits and negative changes associated with the cancer experience.   

The opening session, “Physical Activity, Weight Status and Survivorship,” featured some of the findings from Dr. Wendy Demark Wahnefried’s  DAMES (Daughters and Mothers Against Breast Cancer) trial, which recruited pairs (mother and daughter) to look at whether the mother daughter bond could serve as support and motivation for weight loss in overweight breast cancer survivors.  Despite the study’s success – even the control group lost weight in the mother-daughter pairs – future studies would probably be expanded to “mothers, daughters,“ Wahnefried said, “and others. There were some daughters who didn’t want to participate with their Moms.  Next time we’ll cast a wider net.”

Hopefully findings can be applied to this and other programs that help survivors lose weight. A body mass index (BMI) greater than 25 and weight gain during adulthood are both associated with an increased risk for breast cancer, not to mention other cancers and heart disease. 

“We have data from observational studies that physical activity not only enhances survivorship but lowers the risk of recurrence, but we have to back that up with long-term studies,” Wahnefried said. “What’s safely said?  Avoid physical inactivity.”

Ultimately it comes down to cells and chemistry.

In an experiment published late last month in Science Translational Medicine, researchers from Harvard and other institutions used mass spectrometers to analyze blood samples taken from a group of unfit, healthy, and super-fit (marathon runners) individuals.  In each group marked changes in metabolites, which drive metabolism, were activated in as little as ten minutes of exercise.  The metabolites also ignited reactions in other genes, specifically those regulating cholesterol and blood sugar.  (3)  

These preliminary results and others studies like this, will one day show the interactions of exercise, blood chemistry and the immune systems’ ability to fight off marauding cancer cells.

Until then let’s continue to gently support and encourage greater fitness and healthier eating patterns in all our sisters with cancer.

Would you be willing to try a health and fitness program with your Mom?  Or would that bring up too much family drama?  How about your daughter?

Illustration Credit:  Bryan Christie. NY Times Magazine.

Notes: 

1.       1.LiveStrong, Austin, Texas.  How Cancer Has Affected Post-Treatment Survivors. 2010

2.  Rowland, J.H., Aziz, N.M. Tesauro, G & Feur, E. (2001) The changing face of cancer survivorship.  Semin Oncol. Nurs 17: 236-240.
3. Reynolds, Gretchen (2010) A workout for your bloodstream.  NY Times Magazine, June 20, 2010: 16.

My Other Life

Still Life with a Curtain / Paul Cezanne, 1895

Earlier this month Marie posed an invitation to her readers to discuss their "other" or real lives. At the time I posted something to the effect of "it's all there." I said this totally without irony or sarcasm.

That's how deeply I feel about writing. Every time I put together a post, or an article, I am all there. What I think, what I value, the words I choose, the topics that matter to me. That's truly who I am, before cancer, after cancer, during cancer, without cancer.  That's my voice. Cancer's run a parallel path throughout my life, which I wrote about in some detail in other essays and discussed on the SIRIUS XM program, "Dr. Radio" with NY Langonne Medical Center oncologists Abe Chachoua ("Dr. Handsome") and Silvia Fomenti. The fact is I can no longer separate cancer as a distinct entity any more than I could write about life and leave out my husband, my sister, or my friends.

Through Twitter and Facebook -- you all know I cycle, that I adore my dog, that I'm a Stephen Minister and a lot of other things. A good afternoon is one in a museum, or hiking, or cycling in a competent pack on a cool, crisp day. Nothing better. I quilt when I have time, but I haven't had time for awhile now. I'm an occasional cook (and a good one) who lives in Texas and complains relentlessly about the heat. Second to writing is reading, and I love to travel. Both stir the mind and stirring things up is good for the soul. It's how I hang.

A deeper thread to the story is right here, my husband Steve's cancer story. This was written before his most recent recurrence, a process that involved extensive plastic surgery that kept a "flap" of skin in place securing his ear to his neck for some three months. He says my cancer made his seem like the flu and I say his made mine seem like a walk in the park. What I can tell you is this: his stitches were removed early in June and two weeks later he competed in the Senior Olympics here in Houston. That's cool.

 

So now I see I have started my entry about why I won't write about my other life. When I write you, this IS my life:)  All I can say if make sure it's about love.  That's why we're here.

Jody

Data Drop

 The 47th annual meeting of the American Society of Clinical Oncology (ASC0) I attended last week in Chicago is bigger than the town in Iowa where I grew up.
       Some 32,000 of your nearest and dearest in all things oncology gather in McCormack Place, a sprawling, four-building complex that has a walkway over Lake Shore Drive and boasts its own restaurant directory. McCormack Place makes an airplane hanger seem positively cozy by comparison.
       To this add: a data drop the likes of which are impossible to fathom. There's the abstracts alone for starters (some 4,000); a five-day program with sessions running from 7:30 am until around 6 p.m., and an exhibit hall with everything from big pharma's comfy barcelona chairs, to small booths for advocacy groups and miles of poster exhibits for every known cancer and many you've never heard of before.

The "Hangar" - Exhibit Hall "B" 16 total screens

       "Melanoma stole the show," ASCO past president George Sledge, MD, wrote in his blog. By now I'm sure you've seen some of the coverage (NY Times write up here by Andrew Pollock) describing the 'notable progress' two new drugs have shown in prolonging disease progression in patients 
with metastatic melanoma, a disease 
notoriously difficult to treat.  
        It was a case of metatstatic melanoma and the death of a friend's sister (she was 46) that was the impetus for starting this blog two years ago. These developments may have provided Denell with the commodity in short supply: time. Time simply to be together with her loved ones. Are these perfect treatments? No. Are they curative?  No, but none of us can place a value on another year of life, either. 
        I'll be writing in depth for OncologyTimes next week on notable sessions in survivorship, screening and breast cancer, from prevention to triple-negative bc and a few things in between. It was stunning to sit in on these sessions.  All night long I'd think about cells and try to rephrase what I'd learned, the clack of the train across the tracks echoing in my ears.
        What did I see at ASCO?  We take our cancer seriously; so do the oncologists and professionals I met. You could hear it.  You could see it on the faces of one presenter to the next, as each one personally thanked their patients for participating in the clinical trial they were discussing. There were times when the pauses between questions from the audience, or between slides, said much more than the scientific language could convey. Language is sometimes limited, but 32,000 people, from 121 countries, in one place for five days trying to hash out the next best plan for cancer? That's a lot.
         It was inspirational.  Enough so that when I developed blisters the last day I just kept walking. 
         
         A few convention notes:


        1)  Biggest game in town: the Starbucks line.
        2)  Second biggest game in town:  taxi line.
        3)  Third biggest game in town: Cell phone charging stations; and not enough of them.
        4)  If you have to ask: you've waited too long.  Map restroom locations in advance.
        5)  Understand that the things you really, really want to visit are on the opposite side of  the center.
        6)  Smoking. You don't but you'll be shocked to see how many still do. Go figure.
        7)  High heels. My feet are shaped like feet, not hooves.  Many women were stylin' in sky-high heels while I was longing for shoes with the word  "Easy" in the name. Repeat slogan from above.
        8)  Daily Newspaper:  that's how much data drops daily. Every morning there was a 12 - 16 page newsletter covering sessions, with links to photos and video.
        9)  Sleep.  Who needs it?  The sun rise begins around 5 am.  You might as well stay up.
        10) Best thing to carry?  As little as possible.  Hotel key card, a pen & small tablet.  You're good to go.


Later,
Jody


Advances in Women's Cancers - Interview with Andrew Seidman, MD, of Memorial Sloan Kettering Cancer Center.  Video by American Society of Clinical Oncology, Alexandria, Virginia.
Coverage on Colorrectal Cancer -  by Kate Murphy, Fight Colorectal Cancer Coalition

Much Ado About a Lot

An issue affecting the breast cancer community came across my desk yesterday. Take a look at this talk by Ivan Oransky, MD, director of Reuters health, that was posted on Gary Schwitzer's Health News Review  June 6. It’s a puzzling talk about overtreatment and medicaliazation that takes a surprising turn toward the end.

         Medicaliazation is just what it sounds like - taking normal life processes like menopause, and building its symptoms into a 'condition' that pharma then develops medications to treat.  Medicaliazation leads to the television and magazine ad campaigns you know and love. My favorite is the perky Sally Fields, of "YOU LIKE ME" Oscar fame, waxing rhapsodic-ally about Boniva, as though taking biophosphonates were as easy as having a picnic with the grandkids. They aren't. 

          In his talk Dr. Oransky points out approximately 270 women have to be treated for three years with biophonates to prevent one bone fracture, a fact I was glad to know but not necessarily a stunning example. Some better ones are described in Otis Brawley's book, How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.  His discussions of well-insured cancer patients being treated with "the latest and greatest" (expensive) chemotherapy drugs in private clinics will curl your toes. That is overtreatment. It is overtreatment when patients demand unproven therapies and physicians, who don't want to lose that patient to someone else, acquiesce. Prescriptions are written. There are a number of yearly lab tests for otherwise healthy adults that are now considered to be excessive. These are the examples of medical excess that clog the financial arteries in our health care system. 

          But then suddenly, and I can only conclude deliberately, since this was a Ted talk and not an impromptu chat around the water cooler, the word previvor became part of the conversation. 

          That Dr. Oransky finds some"pre-conditions pre-posterous" is not a point of contention to me. I get that. Journalists, as he points out, medicalize different risk factors all the time. You can read those daily on any news aggregator and worry yourself sick. Some of the conditions Dr. Oransky cites, like subclinical acne (um, the absence of pimples in case you were wondering) are funny. Who needs navel gazing? As a woman who has had cancer - that uninvited, sudden and disruptive guest – my own patience with disease mongering is nonexistent.

          But I don’t personally group navel gazers, medicalizers, hypochondriacs (might as well say that, too) or the “worried well” in the same category as women at risk for hereditary breast and ovarian cancer. No way.  Some call it “hereditary breast and ovarian cancer (HBOC) syndrome. That is distinctly and completely different. Notice that I also didn’t include the word previvor, coined by the advocacy group FORCE, in my distinction, for reasons I hope to make clear.

          No one is destined for cancer and everyone, by nature of being alive, is at risk. The only sure risk factors for breast and ovarian cancer for those without a mutation are: 1) being a woman with both breasts and ovaries and 2) growing older. From a medical standpoint, since 'pre' means before, does the word previvor denote the fact that cancer is in fact, inevitable? As Dr. Steve Tucker pointed out yesterday on Twitter, a mutation in one's DNA does not a disease state make.

         Not everyone who has a BRAC1/2 mutation will develop breast cancer, but a good percentage of them, over the course of a lifetime, will. That number ranges from 60%, or five times the risk as that of the average woman, according to NCI.  Cancer.netlists that risk in a range from 50 – 80% and Myriad Genetics, the company that holds the patent on BRAC testing, lists the risk factor for breast cancer from 56-87% (before age 70) on its website bracnow.com.          

         If the point of the talk was not to take issue with the women who carry this deleterious mutation, whether they call themselves previvors or WWDM (women with deleterious mutations), it wasn’t readily apparent to me when I watched the clip. In the conversation that resulted on blogs, however, and not the Ted Talk itself,  Dr. Oransky later wrote, “The problem is that there are hardly any people alive who do not have ‘some other predisposing factor’ for cancer, which makes FORCE’s definition far too broad to be useful. That was my point.”

         Well, true enough. We can begin to split hairs all day long.  It seems that the phrase “some other predisposing factor” is the issue.

         Is an organization that supports women with a heightened risk for cancer, as defined through genetic counseling (which FORCE recommends) disease mongering? Of all the nonprofits out there with curious agendas this is not one I would have chosen. The irony to me is how a group working proactively to grapple with and reduce their risk factors for cancer is held up in the spotlight in the first place. There are any number of nonprofits chronicled by breast cancer advocates that are far more slanted in their approach and promotion of mammography as the end all to be all, even though experts will tell you privately that if a mammogram isn’t digital you might as well not even have one.

        This TedTalk, and the conversations that came my way have given me much to think about. So you understand what I’m talking about here, I encourage you to the listen to the talk. Here are the words that stopped me cold:

        “The good news is if you can survive to the end of my talk … you will be a previvor (audience laughter). Now, I made up pre-death….I didn’t make up previvor. Previvor is what a particular cancer advocacy group would like everyone who just has a risk factor, but hasn’t actually had that cancer, to call themselves. You are a previvor. We’ve had HBO here this morning, and I’m wondering if Mark Burnett is anywhere in the audience… I’d to see a reality TV show called Previvor.  Anyone who gets a disease is off the island.”

          Disease mongering is one thing.  Holding up an advocacy group for ridicule? Whether intentional or not? You decide.

        *   *    *

Additional links: http://theoranskyjournal.wordpress.com/2012/06/05/pre-games-previvors-and-pre-death-my-tedmed-talk-on-what-medicine-can-learn-from-moneyball/

http://theoranskyjournal.wordpress.com/2012/06/12/whats-a-previvor-cancer-advocacy-group-that-coined-term-objects-to-how-i-used-it-at-tedmed/

I am compiling additional posts and will add them here.  Right now it's late Wednesday evening, and I have more work to do. We've just learned that Susan Love, MD announced a diagnosis of leukemia.  In l998 when I was diagnosed, her book on breast cancer was my guidebook.  I wish her all the best and am grateful for her continued advocacy on the behalf of women with breast cancer.  

Zappos CEO Tony Hsieh Delivers Happiness

Last year the "science of happiness" turned ten.  While my post-depression era parents would have been perplexed at the thought of studying happiness, the quickly growing field of positive psychology has since initiated hundreds of studies, titles and headlines about what makes our hearts and souls thrive.

          During the very same time eleven-year period a Harvard graduate, entrepreneur and venture fund manager by the name of Tony Hsieh (pronounced “Shay”) established and grew an innovative on-line shoe retail company to $1.2 billion in gross merchandise sales. The company is ZAPPOS and the rest isn’t history -- but yet to come.

          Let's stop right now and think for a minute.  We are so accustomed to sentences packed with hyperventilating numbers that it's easy to lose track of what they mean. Even if you do a simple equation, say, shoes at an average cost of $30.00 per pair -- that is 10 million boxes of shoes a year, just a million shy of all the cancer survivors in the United States. In a year.  The shoes don’t fit? No problem.  Shipping is free in both directions.

          Now ZAPPOS CEO founder Tony Hseih tells us the story of Zappos and its "culture-driven" path to success in his first book, Delivering Happiness, an immensely readable, often funny account of the best example of “failing forward” that the business world has seen in a very long time. This is a guy everyone thinks is cool. Because he is. He writes clearly and makes all his accomplishments seem effortless, just as right as rain, perhaps a clue about his particular genius. 

          The book is easily divided in three sections – ‘Profits,’ ‘Profits and Passion’ and ‘Profits, Passion and Purpose’ and starts with Hseih’s entrepreneurial beginnings at age nine selling earthworms. During his first year in high school he found the computer lab, where the rest may have indeed become history. Within two years he was teaching PASCAL to summer school students.  At Harvard he ran a pizza business in lieu of attending class. After a short stint at Oracle as a software engineer, he went on to establish LinkExchange, which he sold to Microsoft for $265. He was 24.

           In fact, everything about Tony Hsieh's accomplishments, his values and ideas about customer service are so superlative -- kindness, FUN, honesty, meaningful relationships, clear communication -- that I found myself searching for dark spots. I don't know if that's the albatross of middle-age or because I grew up in the Midwest where you always wore clean underwear (not because you wanted to) but because you might-get-hit-by-a-car-and-end-up-in-the-hospital.  

          What finally dawned on me after I finished Delivering Happiness was the gift of facing life with confidence, and what can happen when you stay on track. Because another thing that Delivering Happiness illustrates from both the personal and business perspective: making your customer incredibly, delightfully, and “WOWfully” happy takes laser focus  -- from hiring, to empowering your employees, to not just defining core values but putting them in action.  It ain’t at all about the shoes, Willis.  

             Delivering Happiness is about creating meaning and value by turning traditional business models sideways.  It isn’t about all the things you can’t do, but how you can apply your own talents and derive the greatest possible experience from what you undertake as long as it is something you are passionate about.  When he makes mistakes, Hseih says so.  He passes on the invaluable lessons he has learned.  Just a few:  

         Never outsource your core competencies.  

           Without effort, inertia wins.  

           Make your core values your life values.  

           Ask anything.

         Enjoy this book.  Tony Hsieh absolutely fills the pages with all he knows and gives it all away many times more. That is leadership, an incredible story that puts the word "why" and "wonder" back into our vocabulary.

NOTE: Stay tuned for info on how to get a free copy of Delivering Happiness.  If you'd like to purchase a book from Amazon go to: http://www.amazon.com/deliveringhappiness .  I was provided with a free advance copy with the understanding that I would write an honest review, which I did.  I really enjoyed the book -- jms

A Tribute to Survivors of Cancer

A Tribute to Survivors of Cancer
Originally uploaded by Schumata

Houston has an extraordinary monument dedicated to cancer survivors as you approach the museum district and Texas Medical Center from downtown on Fannin.

The first time I visited this lovely place, where the vista opens to  wide boulevards and the solace of towering live oaks, there were six of us.  All breast cancer survivors. We'd attended a National Cancer Survivors Day brunch and everything that comes with such an occasion. We cried, laughed, then really cried, then really, really, laughed and probably experienced as much emotion as possible without collapsing into a heap.

To me that has always been and will be what National Cancer Survivors Day is all about - be with friends, eat a good meal, clink glasses, take photos, and build each other up.

But I don't think we need a special day, because every single day already is.  All good things to each and every one of you.

Blessings,
Jody

Mets On My Mind

Photo of Anna Rachnel & me at NBBC by Nancy Uvmer, NH.

This year May started and ended with two entirely different conferences -- the National Breast Cancer Coalition's Annual Training Conference in Washington at the beginning of the month and the annual meeting for the American Society of Clinical Oncologists in Chicago beginning Friday. This is an especially humbling opportunity to listen, learn from and talk to experts from around the world in every conceivable type of cancer, survivorship, palliative care, and clinical practice management.
         Pre-conference posts like this one, from Eric Rosenthal writing for OncologyTimes, point out that this won't be a "BIG THREE" conference -- cancers of lung, breast, and colon -- but " 'the year of small tumors' with the Sunday afternoon Plenary Session featuring studies on melanoma, GIST tumors, and childhood cancers." There are also significant developments in ovarian cancer, something that has been a long time in coming, according to Sally Church, a scientist and consultant.
         But before you get discouraged -- keep in mind that there are more than 1300 abstracts in breast cancer alone spanning six different categories, from prevention to triple negative cytology. There will be more than enough for me to feed on for the rest of the summer. Key? All the background work I can accomplish while I'm there so when (not if) a breast cancer breakthrough drops I'll be ready to catch it.

While I'm preparing for this conference the blogosphere's been on hyperspeed.  Last week my new column "Anchored Activism" was published in OncologyTimes. A number of people weighed in on the topic of NBCC's baseline report Deadline2020. My interest then and now is following research in the understanding and prevention of metastatic disease, the Bermuda triangle of breast cancer.
         In the meantime, in cancer culture Komen once again did something none of us could even make up. "Sometimes, I swear," Kathi Kolb said on her blog, "these posts write themselves." She was talking about the unbelievable new product for the cure, "Promise Me" perfume.  The line between fundraising, "brandraising" and mass consumer slop have just coagulated into something so divorced from cancer it isn't even funny. The ultimate irony, as Lani Horn pointed out, is that the smell of perfume makes the majority of survivors sick.  I'm one of them.  After treatment walking into any closed space - an elevator, conference room, even a hotel lobby - where women waft in perfume is enough to kick off a migraine.
         If we weren't talking about cancer some of this might be weirdly amusing.  But we are.  And according according to the Chronicles of Philanthropy, Komen is one of the most highly regarded charities in the United States. Thanks to the voices of Gayle Sulik, Anna Rachnel, and Katie Ford Hall, among others, there's a serious spotlight shining on all Komen activities.  In the coming months I'll be adding in my thoughts.
        Two more things.  Last week Brenda Coffee's post, "Hang On to Your Husbands" spurred a lot of thought about cancer and relationships. Cancer leaves everyone vulnerable and exposed.  A plague on anyone who preys on couples - or singles - during a stressful time.
         Then today, in her beautiful way, Marie created a forum for women to discuss their lives, before and after in "My Other Life."  The threads of my life have remained steady even though many of the details continue to evolve and change. What runs through mine is passion, reading, writing and commentary.  I love to laugh but I'm rarely frivolous. I've found, through my friends in the cancer community in general and the breast cancer community in particular, a place where all my interests fuse and I can best make a difference.  This has taken the greater part of 50 years. Thank God I've finally landed.

Later, friends.  I'll tweet you from Chicago.