Living in your “GENES”

Angelina Jolie and The Dirty Little Secret of the BRCA related cancers

You can read about Angelina Jolie and The Dirty Little Secret of the BRCA related cancers on More.com

No one wants to hear that they have breast cancer. Many women don’t  really want to know that is not “if they will get breast cancer”, but “when they will get breast cancer.” Our mothers and grandmothers didn’t have the choice to know if they were carriers of the BRCA variant genes when they were young as the testing did not exist.  What they didn’t know did hurt many of them but they didn’t have the difficult decisions to make about their futures that

We do!

If only my crystal ball was working...

If only my crystal ball was working…

If it could tell us the day before the cells decide to stop dying at the appropriate time  and cancer was beginning its uncontrolled cell division. We would choose not to get breast cancer. We are able to choose the pair of jeans to house our legs, but we have no choice over the pairs of genes that make up our DNA. ( at least not yet!)

The BRCA I and II hereditary breast and ovarian cancer genes are the genetic variants that we know of at this time that are the most common genetic mutations that cause and increased risk of  breast and ovarian cancer. Who’s at risk? Great question. There are several red flags that alert us as clinicians to offer testing to individuals who have a significant risk of carrying on of these genetic variants.

Personal history of breast cancer < age 50 years

•Family history of multiple cases of early onset breast cancer

 •Ovarian cancer (with family history of breast or ovarian cancer at any age)

 •Breast and ovarian cancer in the same woman

 •Bilateral breast cancer or 2 primaries in same breast

•Ashkenazi Jewish heritage any age ( 1/40 AKJ individuals carry the gene compared to 1/500 non AKJ)

 •Family history of male breast cancer any age

•ER-, PR-, Her 2 neu- ( aka triple negative breast cancer) < 60

•Personal hx Pancreatic cancer any age with 2 close relatives with breast/ ovarian or pancreatic CA any age

•Limted family structure  ( adoption, death of women by 45)

The BRCA I and II variants are found on chromosome 13 and 17

The BRCA I and II variants are found on chromosome 13 and 17

If you feel that you fit the above criteria, talk to you healthcare provider to be referred to a physician or genetics counselor to discuss your personal family pedigree and determine if testing is right for you.

If you are found to carry one of the variant genes, you are at increased risk for breast and ovarian cancer

—50% chance of breast cancer by 50
—87% chance breast cancer by 70
—44% chance of ovarian cancer by 70
—Significant increased risk of a second cancer
—Relatives need to be tested
—Options carefully weighed
Understand medical surveillance is an option

Making a decision to have risk reduction surgery is personal and you are the one who has to live with that decision every day. Everything in life has risks and benefits and all of them need to be taken into consideration when a decision is made. Many women chose to have close clinical surveillance with mammograms, MRI’s and clinical breast exams. Tamoxifen, an estrogen blocker can decrease the risk of an estrogen sensitive breast cancer by nearly 50%. We have innumerable patients who are followed clinically and they are quite comfortable with their decision.

BRCA gene-related breast cancers are associated with a high incidence of triple negative tumors. These are fast growing cancers that can appear suddenly as large tumors in just a few months. BRCA positive patients follow a six month screening routine alternating between mammogram and MRI. Triple negative cancers can pop up in the interval between screening exams. This is one reason that more and more women who carry a BRCA gene choose to have risk reduction surgery with reconstruction. Surgically, we are often able to preserve the nipple complex providing patients with risk reduction and excellent cosmetic results. Triple negative cancers account for approximately 75% of the cancers that occur in BRCA I carriers and 30% of the cancers in BRCA II carriers.  (Less then 11% of breast cancers in the general population are triple negative.) These cancers are fast growing, aggressive, and almost all require chemotherapy as they lack certain cell surface proteins that can be targeted by medication such as Tamoxifen.

So what’s the buzz on ER-, PR-, Her 2 neu-  aka triple negative breast cancer.

Triple negative breast cancers are cancers that begin in the breast and do not have cell surface proteins that receive signals that can either stimulate or block the cells production.  Triple negative is short for ER- (estrogen receptor negative), PR- (progesterone receptor negative) HER 2 neu – (Human epidermal growth factor receptor 2 negative). This means that these tumors lack those cell surface proteins therefore specific targeted treatments will not work in these tumors.

Triple negative breast cancers account for only 10-15% of all breast cancers. Triple negative cancer growth is not stimulated by the hormones estrogen and progesterone, therefore medications to block those receptors will not work in triple negative breast cancer. Herceptin is another “targeted” therapy but is ineffective in Her 2 neu negative tumors as the cells lack the Her 2 neu surface protein.

Triple negative breast cancers are also considered to be more rapidly growing tumors and therefore need to be treated aggressively. They are often call “interval cancers” as they can develop and grow to be quite large (3-4 centimeters, the size of a small lemon) between annual mammograms. The risk of recurrence for triple negative cancers is significantly higher within the first 2 years after the initial diagnosis, and decreases after this time interval.  Hormone positive cancers however, may not recur for 5-15 years after their initial diagnosis.

Triple negative breast cancers are frequently seen in younger women, although the distribution is similar in all age groups.  African-American women are twice as likely to develop a triple negative breast cancer. These tumors are also more likely to be associated with the BRCA I and BRCA II breast and ovarian cancer genes. Approximately 75% of BRCA I carriers and 30 % of BRCA II carriers who develop breast cancer will have a triple negative cancer. For those reasons women who develop this subtype of cancer need to be tested for the BRCA genes.

The local, or breast and lymph node, treatment of triple negative breast cancer is the same as any other breast cancer.  Breast conservation therapy, lumpectomy and radiation, or mastectomy with reconstruction both with evaluation of the lymph nodes is the options.  One important difference, however, is that research has shown that triple negative breast cancers are very responsive to chemotherapy, thus making this treatment option a cornerstone of triple negative breast cancer therapy even with very small tumors that do not involve the lymph nodes.  While chemotherapy is not always a part of the multi-disciplinary care associated with hormone positive breast cancer, along with surgery and radiotherapy, it is an integral part of the treatment of triple negative breast cancer.  Neo-adjuvant chemotherapy, or chemotherapy before surgery, is also frequently used for treatment of triple negative breast cancer to shrink the tumor to allow for better breast cosmetic outcomes.

Triple negative breast cancer has a lower survival rate than other breast cancers. Many factors play into survival rates. According to studies cited at Breastcancer.org, women with triple negative breast cancer have a five-year survival rate of 77 percent, compared to women with other subtypes of breast cancer, who have a five-year survival rate of 93 percent. Having a triple negative breast cancer does appear to raise the risk of death within five years of diagnosis compared to women with other subtypes of breast cancer, but after that five-year time period, the risk diminishes. Unfortunately, mortality rate among African-American women with triple negative breast cancer is much higher than it is in Caucasian women.

If you or a family member has been diagnosed with a triple negative breast cancer, take a deep breath and know that this cancer is treatable! My advice is that although this is an aggressive subtype of breast cancer, there are combination therapies for this particular tumor type that offer her a potential long-term survival equivalent to stage matched hormone positive breast cancers when diagnosed early and treated aggressively. Know that chemotherapy is a cornerstone of treatment and that frequently chemotherapy is given in advance of other therapies such as surgery and radiation therapy.  A team of doctors, including a breast surgeon, a medical oncologist, a radiation oncologist, and frequently a genetic counselor will be involved in the multi-disciplinary care of her health through this difficult time in her life. Genetic testing and counseling are a must!

OVARIAN CANCER RISK

BRCA carries have a 44% risk of developing ovarian cancer by the age of 70. We cannot gloss over the risk of ovarian cancer in this conversation as the ovaries are hidden away in our abdominal cavity and are virtually impossible to screen for cancer. Ovarian cancer strikes silently therefore it is recommended that women who have had their children and carry the BRCA I or II gene have their ovaries and tubes removed at a time determined by their physicians based upon several personal factors. Their risk after removal goes from 44-50% down to 4%. ( The risk is never zero as our abdominal cavities can still produce some progenitor cells that can turn into cancer. < aka primary peritoneal carcinoma>)

KNOWLEDGE IS POWER

Get educated, be empowered. Make decision based on knowledge not in reaction to fear.

“Take risks in life based upon what you may gain, not what you fear you may lose”

A New Day

A New Day

Women Who Make a Diffference

May 12th, 2013

Happy Mother’s Day!

To everyone who reads this who is a mother, know that you are giving the greatest gift to another human being, unconditional LOVE. To everyone who is reading this who has a mother, so unless you were hatched, I mean you… take a moment and thank your mother for all of her love and wisdom that she has given to you whether or not she is still with you. She will hear you even if she is in spirit.

This is my Mom Helena Baughman and I was blessed to spend the day with her.

Every day is a gift, Stay present in the moment.

My Mom Helena

My Mom Helena

Kudos to the YWCA of Bucks County for honoring Women Who Make a Difference!!!

I had the honor and pleasure of presenting two of Bucks County’s Treasures to the more than 300 individuals who attended the YWCA Awards ceremony May 9th, 2013.

Heidi Volpe

Heidi and Beth

Heidi and Beth

Holy Redeemer Health System chose to honor a woman that I could not live without. Heidi Volpe is an amazing nurse, mother, daughter, friend and is the administrator who not only successfully runs the Bott Cancer Center but is the queen of community outreach and simply cares about every aspect of our cancer program!!

Heidi was joined by her father at the award ceremony and was surrounded by patients and friends from the HCF. She sits on the HCF board as the Holy Redeemer representative.

Mary Lou Gilmour

Beth and Mary Lou

Beth and Mary Lou

The Healing consciousness Foundation honored Mary Lou Gilmour as a woman who makes a difference in so many of our patients lives.

Mary Lou is an energy practitioner who provides healing services for our breast cancer patients. She is a vital link to healing from breast cancer and anything that life has thrown at someone. I can physically remove a cancer, but Mary Lou energetically creates the path for healing.

She is humble, exudes love and is absolutely a woman who makes a difference with every breath she takes. I am, so blessed to have her working with us through the HCF.

And lastly, I am humbled and honored to have been inducted into Drexel University’s Alumni society The Drexel 100 on May 4th 2013. The Drexel 100 class of 2013 was a pretty amazing group of individuals, I am proud to be one of them.

Janet works for the alumni office and as the day progressed, she realized that I had performed surgery on one of her very dear friends!!

Beth and Janet

Janet and Beth

Drexel 100 Medal

Drexel 100 Medal

It’s A Wonderful Life!

“Healing” in the Operating Room: What a novel thought!

IYS

IYS

I have been performing surgery for over 26 years and the wonder of what takes place in the “operating theatre” as they call it in the UK and Oz never ceases to amaze me. I am not referring to the physical surgery, I am referring to the trust a patient has when they surrender completely to physicians and nurses that they barely know. They trust that we have their best interest in our hands. For many of you who are reading this, if you have been in the OR, you were likely asleep when you were there (frankly I prefer to be awake  when I am in the OR having been both the surgeon and the patient).

The perception of what happens in the OR is typically gleaned from the television or movie impressions. It’s not just the scripted shows, but the reality TV era that has shaped our views and impressions.

  • Trivia question- Who performed the first live reality surgery on the web??
  • If you answered Dr Beth DuPree and Dr Robert Skalicky, you would be correct. October 1999 we had the honor of educating 1.3 million viewers as they watched a LIVE BILATERAL MASTECTOMY AND RECONSTRUCTION. Patty Derman was incredibly brave and a healer in her own right as she chose to educate millions of women and men and bring them on her journey to healing. The event was huge and ended up receiving a coveted Gracie Allen Award for excellence in broadcasting and a feature in the New York Times. (It didn’t launch my TV career as a ‘TV Surgeon’ so I had to keep my day job)
    The Internet Surgery and America's Health Network Show

    The Internet Surgery and America’s Health Network Show

    Gracie Allen 001

    Patty Derman holding the Gracie Allen Award surrounded by her surgeons and America’s Health Network team

My daily operating room routine may be an experience that is a bit different from the standard OR experience. I typically escort my patients from the holding area into the room, holding their hand, their attention, their energy and the intention of healing for their highest and best (without judgement of what healing looks like for them). You cannot focus on fear or allow anxiety to set in if your attention is being held on another topic. It could be that I am simple distracting them from their fear, but isn’t that a good thing??

As they drift off to sleep under anesthesia, I hold their right hand in my left hand and place my right hand over their heart. (call it prayer, Reiki, energy healing, focused intention, what every you like- I am simply holding that individuals energy sacred, which creates the atmosphere in the OR that what I am doing surgically is sacred work). I use guided imagery and have them visualize going to a place of their choosing that brings them joy and peace in their heart. It is as simple as that.

Several times in the past, I have had healing practitioners come to the OR with me at the request of the patients. Their experiences have been profound and I believe that we need to explore, in a clinical trial setting, how this works for the patient and the staff.

Savitur Dhanvantre

Savitur Dhanvantre

I have been asked repeatedly by nurses and anesthesia “why do you bother doing that?” as the patients have been given drugs to make them forget. My reply is simple- patients are aware of everything that takes place in the OR whether or not they can access it readily. Their conscious mind may be on a mini vacation, but their unconscious mind is well aware of everything.

If you work in the operating room, remember that the person who is on the table is scared, vulnerable, and wide open so please be respectful of this at all times.

Ignite Your Spirit!

Recently, I had the great fortune and grace to have an amazing healer in the operating theatre with me. Savitur Dhanvantre, a master healer, from Shanti Mission Australia not only joined me in the OR but was able to prepare my patients for the experience with pre-operative , intra-operative and post-operative healing.

Savitur Dhanvantre

Savitur Dhanvantre

Sounds kinda funny to talk about “HEALING” in the OR as something spectacular but in our Western world, the OR is thought of as that place where cancer is “cut out”, bones are repaired or tissues are removed. Clearly the “physical body” of cancer or repairing abnormal conditions in the body is only one aspect of healthcare. I know that healing has been occurring with my patients as I am surgically removing the tumors, but I liken this to quantum healing to healing the physical, emotional, and spiritual. Energetically, the patients are shifting spiritually as the surgery shifts their bodies physically.

So, how did this all come about? During my two week trip to India, a plan had been put in place to have Shakti Durga come to the OR with me while she was in the USA. Her plans changed as she was called to return to India.  Instead, Savitur was chosen to  come to the USA for a retreat. Savitur obtained his TB test and provided all of the documentation to come to the OR to be present with the patients. I obtained written permission from all of the patients to allow Savitur to work with them. The hospital staff was alerted and all were open to the possibilities.

All of my patients that received healing that week had profound and amazing shifts in their physical, emotional, and energetic bodies. Anxiety, fea,r and stress melted away. Post-operatively each woman was visibly calmer and more at peace. One patient had such severe anxiety that after a simple ten minute pre-op session with Savitur, the pre-op nurse thought that the anesthesiologist had given the patient versed (a strong medication that wipes away anxiety temporarily). The patient’s husband asked if he could take Savitur home with them.

Another patient had had several previous surgeries and said that this one was “grace and ease”. No anxiety,no pain, and no worries.

So many individuals hold on to beliefs and behavior patterns that do not serve them. I do not know if it is the word “cancer” that allowed these women to make such profound shifts in their energy bodies but the changes were not only perceived and felt by the patients, but by the families and the staff as well.

Quantum Healing

Quantum Healing

IMG_9517

My treatment of the physical disease cancer is rooted in western medicine. High tech and cutting edge. My treatment of the spiritual and emotional aspects of my patients is rooted simply in healing. Healing comes in many forms. There are so many therapeutic healing modalities available, we just need to give our patients access to them.

My work with The Healing Consciousness Foundation is of the utmost importance to me as it has given us the vehicle to allow women and men affected with breast cancer to not only experience state-of-the-art western medical care of their physical disease, but it allows them to find healing deep in PEACE in their Heart.

PEACE IN THE HEART

PEACE IN THE HEART