Dr. Carol Rosenberg (NorthShore)
This is an excellent question. It brings us to discuss an important study called the Women's Intervention Nutrition Study (WINS). Women with prior breast cancer who reduced fat in their diet reduced their risk of cancer occurrence compared with women who did not. The important point here is that these women who had the greatest decrease in the risk of of recurrence were triple negative breast cancer (i.e. estrogen negative, prog. negative, her 2 negative) Thus the most important thing that you can do to reduce the likelihood of a recurrence is to follow three lifestyle imperatives: 1 - A low fat diet full of fresh fruits and vegetables. 2 - Physical activity at a minimum of 30 minutes moderate intensity walking a day, seven days a week 3 - No more than three alcoholic beverages a week. Also remember that some of the most important revelations about decreasing recurrence rates in women with breast cancer are related to lifestyle changes that are in your control. (Cont.)

Dr. Carol Rosenberg (NorthShore)
The answer to this question is similar to the previous answer. That is, absolutely you can lower your risk with the modifiable lifestyle steps of weight management through plant-based diet, physical activity and limited alcohol consumption. And, of course, no smoking.

Dr. Carol Rosenberg (NorthShore)
Every survivor needs to make the transition from the intensity of the oncology treatment environment back to their community, their family and their primary care environment. While being treated for cancer you are coddled and cared for by medical, surgical and radiation health professionals. But the new normal until this time has been a "do it yourself" situation. A Survivorship care plan is an important piece towards having an organized approach towards the rest of your life when out of the oncology treatment environment. A Survivorship care plan consists of the following: 1 - A summary of the survivor's cancer history and treatment in order to help survivors better understand their medical history. 2 - A personalized risk assessment with medical surveillance guidelines to instruct the survivor regarding the monitoring for a potential recurrence, a second malignancy and the long term and late affect consequences of cancer and their specific treatments. (cont.)

Dr. Carol Rosenberg (NorthShore)
The definition of Survivorship is really from the first day of diagnosis onward. The LIFE program is ideal for survivors who are out of an active treatment protocol but still on long term adjuvant hormonal therapy as you are. We invite you to make an appointment with us for your Survivorship care plan. 847-926-5818.

Dr. Carol Rosenberg (NorthShore)
The LIFE program offers monthly Survivorship 101 seminars which address the science of Survivorship diet and physical activity recommendations. Entitled "Eat to Beat Malignancy, Walk Away from Cancer" this particular seminar is a 2.5 hour workshop with interactive discussion and the expertise of myself, Carole Martz RN and an oncology dietitian. We're holding a program tonight, but you can register for our next one to be held January 27th. All are welcome and there is no charge for this seminar. Learn more about it at northshore.org/life .

Dr. Carol Rosenberg (NorthShore)
Most recently at the San Antonio Breast Cancer Conference (12/09) several papers linked alcohol with poor Survivorship. We know for certain is a carcinogen and increases the risk of breast occurrence. We now also know on the basis of several new studies from the SABCC that the risk of recurrence among breast cancer survivors is 34% higher among those who drink three drinks a week as opposed to those who drink none. By a drink we mean 12 oz. of beer, 5 oz of wine or 1.5 oz. of spirits. Additionally one Danish study that obesity, smoking and alcohol together influence the development of a second primary breast cancer in the opposite in estrogen positive cancer survivors.

Dr. Carol Rosenberg (NorthShore)
If your wife is no longer having periods then she is considered post-menopausal. Cancer treatment can also affect the hormonal mileau altering estrogen levels and thereby increasing risk for osteoporosis and ultimately fracture. Your wife's treatments could have impacted this hormonal state and ultimately led to her fracture. Therefore, the most important advice that we give all cancer survivors in order to decrease the likelihood of osteoporosis and ultimate fracture is as follows: 1 - Weight bearing exercise such as walking 30 mins/day 7 days/week. 2 - Calcium supplementation - 1200mg/day 3 - Vitamin D3 - At least 400-600iu 4 - No smoking 5 - No alcohol 6 - Consume foods rich higher in calcium and vitamin D 7 - 10 minutes of sun exposure daily to activate vitamin D stores from the skin We also recommend that the family physician be consulted for a BMD (bone mineral density) testing and the recommendation for possible bisphosphonate therapy.

Dr. Carol Rosenberg (NorthShore)
The most common symptoms for all cancer survivors are: 1 - Fear of recurrence 2 - Fatigue 3 - Anxiety 4 - Weight gain (especially in breast cancer survivors) Of note, depending on the type of cancer and the areas physically affected the physical symptoms as a consequence of the cancer and its treatment may vary. In the case of breast cancer lymphedema (the swelling of the affected arm) is a major concern.

Dr. Carol Rosenberg (NorthShore)
Depending on the type of cancer you have, the national guidelines (NCCN) and your oncologist's familiarity with your particular cancer will dictate the frequency of your monitoring. Most people who are finished with an active treatment protocol are monitored by their oncologist in 3-6 month intervals for the first five years. Some cancers are monitored more frequently, it just depends.

Dr. Carol Rosenberg (NorthShore)
Depending on the type of cancer and the type of treatment will depend on what body changes you will experience. For example, in the case of breast cancer there are surgical aspects of removing a portion of the breast and the consequences associated with that procedure. Chemotherapeutic regimens may cause hair loss or thinning. In addition, some people experience weight gain or weight loss. Radiation can cause skin tanning and some breast changes that will evolve over time.

Dr. Carol Rosenberg (NorthShore)
An important aspect of Survivorship care planning is the knowledge that a survivor has to gain regarding the possibility of a second primary cancer occurring. All cancer patients are at risk for another type of cancer to occur at a greater rate when compared to the general population of people without cancer. For example, breast cancer survivors face a slight increase in risk for the development of another breast cancer, ovarian cancer, uterine cancer, colon cancer and skin cancer. These elevated risks can be enhanced by genetic predisposition syndromes such as BRCA 1&2, hereditary non-polyposis colon cancer (HPNCC) syndrome and hormonal therapy such as tamoxifen.

Dr. Carol Rosenberg (NorthShore)
The question of insurance and employability predominated the cancer Survivorship landscape. Importantly, each cancer survivor needs to understand their rights and their insurance policies. The LIFE program offers an important seminar on insurance and employability facilitated by an attorney with an expertise in this subject matter. I encourage you to attend our next seminar on Nov. 18th at Highland Park Hospital. You can sign up for it online. This seminar will surely answer all your questions specific to your needs and cancer situation. In the meantime you may want to take a look at http://www.cancerandcareers.org.