A long-standing surgical routine affecting tens of thousands of women every year may be changing because of a new study and others like it. The newest study, published this week in the Journal of the American Medical Association, has the potential to provide new options for women facing treatment for early stage breast cancers. It found that routine removal of the lymph nodes in someone’s armpit (known as an axillary lymph node dissection, or ALND) doesn’t improve survival or recurrence rates, and is not necessary for some women.
This means that a significant percentage of newly diagnosed breast cancer patients could avoid this painful surgery, which carries serious side effects — the most common of which is lymphedema, an incurable swelling in the arm that can range from mild to disabling. Women in the study who had their nodes removed also were much more susceptible (70% vs. 25%) to complications such as infections, strange sensations and abnormal fluid buildup in the armpit, the study found.
This study and similar recent research are a continuation of a trend toward less invasive surgery for women with breast cancer, and will provide new treatment options for many women. We encourage women to have a frank discussion with their surgeons about whether this approach is suitable for them. We expect that this option will be available first at major breast centers and with surgeons who specialize in breast cancer surgery.
In a TIME article, our president, Liz Thompson joins the study’s authors in discussing the implications on those affected by breast cancer.
“Patients may or may not be ready because we have been taught that with surgery, radiation and chemotherapy, more is better.”
-Liz Thompson, president of Susan G. Komen for the Cure®
We have invested $2.5 million researching the causes and potential treatments for lymphedema and has also funded studies into the use of sentinel lymph nodes as an alternative to axillary node dissection.
Learn more about lymph node status, SNB and ALND here.
Twenty years ago, we celebrated a tremendous victory in our effort to ensure access to vital breast health services for women in need. Today, as that victory is facing its toughest challenge to date, our leadership is needed again.
With the launch of the National Breast and Cervical Cancer Early Detection Program, women who were falling through the cracks of our health care system and needed help were finally receiving it. It was a momentous, and truly life-saving, achievement.
Since that day, the entire Susan G. Komen for the Cure family has worked tirelessly to educate women in need about this program and to push policymakers to increase their investments so we could reach all women in need. At the same time, we’ve looked for ways to expand access through our community grants and collaboration with providers. The screening program also gave us the opportunity to invest in other important programs to improve the effectiveness and efficiency of the breast health system.
Now, with economic conditions that are straining every state budget, everything we have fought for and everything we have accomplished is at risk.
How big is the problem? Three out of every four states are facing budget holes that range between 5 percent of their total budget, to more than half! That means every program, no matter its worth, is at risk of being cut or eliminated – this includes breast cancer screening and treatment programs. Once believed impossible, this threat is real.
Our experience in California last year, where the screening program was shut down for several months, teaches us that breast cancer screening is not untouchable. Yet as the program was restored last fall, and was preserved in the Governor’s new budget proposal, the California example also teaches us that our voice can be formidable.
We must be vigilant, and not assume any state is safe. Just consider Washington State where Governor Gregoire, herself a breast cancer survivor, proposed a 25% cut in the program, which would zero out state funding for the remainder of the Fiscal Year and reduce access to 5,000 women.
We understand the difficult choices that elected officials are facing. Yet, we also see firsthand the importance of this program – it is there to ensure a lost job and lost insurance doesn’t mean a lost life. These women are our mothers and our sisters; our friends and our neighbors. And they don’t disappear just because the state stops screening them, and neither does their cancer – it just grows undetected.
In Washington State, we’ve already begun to make our voices heard and the initial results are encouraging. Yet Washington is just the first of many states where the Komen family may have to answer the call.
We need your help. We need you to raise your voice and let your elected leaders know how important this program is and that it is imperative that the program’s funding be preserved.
Please contact your local Affiliate to see how you can help. Find your local Affiliate here.
During Black History Month, we’re honoring the African American researchers and clinicians who are helping to create a world without breast cancer. We start with one of the most highly regarded cancer surgeons in the country, our former board chairman known for his skill and compassion.
“When you grant patients hope, you grant them one of the greatest of all human joys, and that is the joy of anticipation, that perhaps, just maybe, there is something that can be done to help them.”
-Dr. LeSalle D. Leffall, Jr.
From the age of nine, LaSalle D. Leffall, Jr., knew he wanted to be a doctor. The inspiration? A wounded bird he nursed back to health.
In September 1945, at the age of 15, he enrolled in the pre-med program at Florida A&M, Florida’s only state-supported, historically black college. Three short years later, Leffall entered Howard University’s College of Medicine in Washington, D.C., and graduated in 1952 at the top of his class. Dr. Leffall’s medical training continued with an internship in St. Louis, residency in Washington, D.C., and a surgical fellowship at Memorial Sloan-Kettering Cancer Center in New York City. He returned to Howard University in 1962 as a faculty member and went on to serve as Acting Dean of the Medical School and Chairman of the Department of Surgery.
Surgery was his calling; he was drawn to the precision, decisiveness, and efficiency of the specialty. Dr. Leffall’s mentors influenced his decision to further specialize in surgical oncology and pursue the fellowship at Memorial Sloan-Kettering. A turning point in his career, it led him back to Howard where he was able to pursue his talents as a cancer surgeon and teacher. Leffall has devoted much of his professional life to the study of cancer, particularly as it affects African Americans. He and his colleagues at Howard authored some of the early papers on disparities in cancer outcomes, including an important article in 1973 that brought to light the alarming increase in cancer mortality in black Americans.
Through various leadership positions, Dr. Leffall has helped shape the U.S. cancer agenda and create programs to address healthcare disparities. He was the first African American president of the American Cancer Society, the Society of Surgical Oncologists, and the American College of Surgeons, and a founding member of the National Dialogue on Cancer (now C-Change). In 2002, President George W. Bush appointed Dr. Leffall to chair the President’s Cancer Panel, a 3-member group that monitors national cancer programs and reports on progress and obstacles to cancer control.
In 2010, we honored Dr. Leffall, who is also our former board chair, for his pioneering work and leadership in cancer health disparities.
One of Dr. Leffall’s enduring contributions has been to train future generations of doctors. During his career at Howard University, he taught an estimated 5,000 medical students and helped train nearly 300 surgical residents. He quotes Henry Adams as he reflects on his love of teaching, “A teacher affects an eternity.” No doubt, Dr. Leffall’s influence as a mentor and clinician will extend for generations to come.
Today is World Cancer Day, and I’d like to call attention to some facts from the World Health Organization about how physical activity can affect cancer risk. I’ve also listed in a separate post the work that we are doing at Susan G. Komen for the Cure to address the world cancer crisis.
As the United Nations World Health Organization Goodwill Ambassador for Cancer Control, I regularly explain the importance of including cancer in the global health agenda. With so many pressing health problems facing governments, some will argue that fighting cancer is too complicated or too expensive. That the focus should be on cheaper and less complicated problems. But the risk of cancer can be reduced by simple measures such as stopping smoking, having a balanced diet, and being physically active.
To mark World Cancer Day 2011, the World Health Organization has released new recommendations on physical activity. The Global Recommendations on Physical Activity for Health state that regular physical activity reduces the risk of not only breast cancer but also colon cancer, coronary heart disease, stroke, diabetes, hypertension, and depression.
The recommendations are the latest tool produced by WHO and its partners aimed at reducing the global burden of non-communicable diseases, known as NCDs, which are responsible for more than 35 million deaths annually, or over 60 percent of global mortality. Developing countries in particular are suffering greatly from such diseases, with over eight million premature deaths from NCDs occurring in developing countries. In Africa alone, deaths from NCDs are expected to increase 25 percent by 2020 if no action is taken.
I am very pleased that the UN General Assembly is placing increased importance on cancer and other non-communicable diseases. In September, the General Assembly will convene a high-level summit on the prevention and control of non-communicable diseases. Chronic diseases have had a major impact on the world population and put a special burden on women who are usually the primary caregivers. The 2011 summit presents an historic opportunity to change how the world deals with cancer and other NCDs, which kill more people than any other cause of death.
The new WHO recommendations on physical activity can be accessed here.
World Cancer Day will, we hope, set the stage for more meaningful work on cancer control on a global scale. As Goodwill Ambassador for Cancer Control for the World Health Organization, and as a breast cancer survivor and 30-year advocate to end breast cancer, I know too well the pain and devastation of this disease. I’ve seen it in my own family, in my sister who died of breast cancer 30 years ago. And I’ve seen it all too painfully in the faces of members of our global family — women dying in undeveloped countries of cancers that might have been easily treated in the West.
Cancer is the leading cause of death around the world, killing more people every year than AIDS, malaria and tuberculosis combined. The World Health Organization estimates that, without appropriate intervention, 84 million people will die from cancer between 2005 and 2015. While the emotional impact of losing a loved one to cancer is immeasurable, the economic impact of premature death caused by cancer is measurable, and it is devastating. A recent study found that 25 nations are losing more than 2 percent of their GDP to deaths and disability caused by cancer. These figures are only for the deaths that can be attributed directly to cancer. Many deaths each year go unreported, because many countries lack cancer registries.
This may be because at one time, cancer was considered a “western” or “rich person’s disease”– I’ve actually been told that in my travels. Now, it is making its way into developing countries and evolving into a global crisis. Reliable public health numbers help explain why cancer cases are growing in the developing world. For one thing, the use of tobacco, unhealthy diet, and other cancer risks are making their way into low- and middle-income countries. And a rise in cancer is also a natural consequence of people living longer due to decreased mortality from infectious diseases. Our very success against those afflictions has extended more lives into the cancer demographic – those middle and later years when cancer is more likely to occur.
Cancer therefore burdens rich and poor countries alike. It is the great equalizer, affecting men, women, young, old, of every nationality and political stripe. Without comprehensive cancer control plans, the developing world is facing a disease tsunami that will overload healthcare systems, strain national budgets, destroy local economies, and devastate families. By 2020, an estimated 60 percent of all new cancer cases will occur in the least developed nations. Amazingly, however, only 5 percent of global resources for cancer are spent there.
I regularly explain the importance of including cancer in the global health agenda, mindful of the argument that with so many pressing programs competing for limited resources, fighting cancer is too complicated or too expensive, especially for low-resource countries. Unhappily, the world does not have a choice. The cancer burden will continue to grow, and with it the economic impact of the disease, estimated at $895 billion in 2008.
My organization, Susan G. Komen for the Cure, is all too familiar with the need to develop and implement global cancer programs. We’ve been involved in international programs for more than a decade and today have breast cancer programs and partnerships in more than 50 countries. We are working to get cancer included in global health agendas, and will keep up that effort through global health programs that seek innovative solutions and the support of country leaders.
Komen alone has already invested millions in international research and community programs, launching education and treatment initiatives in Africa, the Middle East, Latin America and Central Europe. Komen employees and volunteers are on the ground in those regions of the world, sharing what we’ve learned about advocacy, education and awareness, and helping to develop “in country” programs that local organizations can implement to break through stigma, shame and lack of awareness about this disease. We will meet again Feb. 8 in Washington, D.C., with members of the global diplomatic community to enlist their support, part of our continuing effort to engage and activate country leaders, First Ladies and diplomats who can make a difference.
As we seek the world’s commitment, we are also hard at work looking for innovation in the way we educate and screen women in low-resource settings. Last year, we committed to finding cost-effective and sensitive screening technologies, and proposed partnerships to introduce screening and education to existing platforms in low-resource countries; that is, adding breast cancer education and screening to programs already in place for other diseases.
We do this because the need is real and growing. I have held the hands of women in poor countries, dying of breast cancer, many without even the most basic of palliative care. They ask me if their cancers are contagious. They worry for the futures of their daughters, fearful of the shame and stigma that their cancer has brought to their families.
We must move for these women and for future generations. We must move now. And we must move together.
No longer can organizations work in isolation, concerned about ownership over a program or disease. Collaboration and integration is the key to addressing the increasing burden of non-communicable diseases, including cancer, on communities worldwide.
I urge all who have been affected by this disease (and even those who haven’t) to sign the World Cancer Day Declaration and take these first steps to defeating one of mankind’s oldest scourges.
Click the image below to sign the World Cancer Day Declaration.