Why Survivorship Plans Are Important for Women with Gynecologic Cancer

Lori Smith, MSN, CRNP, is a certified registered nurse practitioner in gynecologic oncology at Penn Medicine. She works with women with cancer and immune therapy clinical trials for ovarian cancer. She is also a co-investigator on many other clinical trials focusing on women’s cancer. Additionally, she leads the Living Well After Cancer™ Program within the Jordan Center for Gynecologic Cancer.

It is important for women who have been treated for a gynecologic cancer to undergo a survivorship visit because the time is completely devoted to addressing your concerns and needs. It is also vital that any other medical providers who participate in your care are aware of your past treatments and current plan of care so that they too can manage your health in a comprehensive manner.

Many women who have been treated for a gynecologic cancer often report significant side effects that they feel affect their quality of life. Those reported side effects include vaginal dryness, painful intercourse, fatigue, lymphedema, urinary and fecal incontinence and pain.

Many women also report psychosocial concerns such as depression, fear/anxiety of their cancer recurring, and concern for family members in cancers with a possible or confirmed genetic mutation.


The Living Well After Cancer™ Program at Penn is a member of the LIVESTRONG TM Survivorship Center of Excellence Network. As part of this network, Penn joins several other LIVESTRONG TM centers nationwide in providing patients and their healthcare providers with the tools necessary to develop a comprehensive cancer survivorship plan.

Penn’s cancer survivorship program offers thorough medical and psychosocial evaluations, follow-up visits, and referrals to other specialists as needed. During this visit, team members discuss any concerns you may have related to your cancer diagnosis and treatment history. A cancer survivorship care plan is developed for you, which includes information about:

• Potential late effects and symptoms
• Recommendations for cancer screening (recurrence or new primary)
• Psychosocial effects (relationships and sexuality)
• Financial issues (work, insurance and employment)
• Recommendations for a healthy lifestyle
• Genetic counseling
• Effective prevention options
• Referrals for follow-up care and a list of supportive resources
• Fertility or reproductive options.

Also during this visit, a complete, personalized care plan and treatment history is created using the LIVESTRONG Care Plan tool. This tool can be found on OncoLink.org and can be completed in the office or anyplace you have computer access. The LIVESTRONG Care Plan provides you with a detailed account of your past diagnosis, treatment history and information about your follow-up care, symptoms to watch for and a report to your healthcare provider. It also provides you with helpful tips to stay healthy.

If you were treated for gynecologic cancer at Penn Medicine and would like to make an appointment for a survivorship visit, please call 215-662-3318 or 800-789-PENN (7366).

Watch the 10th Focus on Gynecologic Cancers Conference.

Learn more about the Jordan Center for Gynecologic Cancers at the Abramson Cancer Center.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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Food Safety Tips for Holiday Meals

The holidays are a time for family and friends to come together and celebrate. In most instances, that means that families share meals with one another. Whether it is practicing food safety when preparing the meal or reminding hosts about their guests' safety, here are some safe food handling reminders to ensure guests enjoy their holiday meal. These concepts are especially important if one of the guests has recently been diagnosed or is in active treatment for cancer. Cancer patients are immunodeficient and therefore are more likely to be susceptible to foodborne illness.

Separate: 

• Washing raw poultry, beef, pork, lamb, or veal before cooking it is not recommended. Bacteria in raw meat and poultry juices can be spread to other foods, utensils, and surfaces.
• Hand washing after handling raw meat or poultry or its packaging is a necessity because anything you touch afterwards could become contaminated.
• It is important to prevent cross-contamination from raw meat or poultry juices by washing counter tops and sinks with hot, soapy water. You may sanitize with a solution of 1 tablespoon of unscented, liquid chlorine bleach per gallon of water.
• Packaging materials from raw meat or poultry also can cause cross-contamination. Never reuse them. These and other disposable packaging materials, such as foam meat trays, egg cartons, or plastic wraps, should be discarded.
• Don't use the same platter and utensils that held the raw product to serve the cooked product. Any bacteria present in the raw meat or juices can contaminate the safely cooked product. Serve cooked products on clean plates, using clean utensils and clean hands.

Thawing:               

• Refrigerator: The refrigerator allows slow, safe thawing. Make sure thawing meat and poultry juices do not drip onto other food. Place item on a plate, and keep on the lowest shelf of the refrigerator.
• Cold water: For faster thawing, place food in a leak-proof plastic bag. Submerge in cold tap water. Change the water every 30 minutes. Cook immediately after thawing.
• Microwave: Cook meat and poultry immediately after microwave thawing. 

For those who choose to go out to a local restaurant to enjoy a holiday meal, here are some helpful tips to use when assessing a place to eat.

Eating Out and Food Safety:

When choosing where to eat out, evaluate if the restaurant is likely to follow all of the above food safety practices. 

While at an increased risk for foodbourne illness, avoid eating at:

• Salad bars,
• Buffets,
• Or trying samples, as these foods may have been left out for more time than recommended. 
• Similarly, food carts and street vendors may not be subject to the same regulation as restaurants, and therefore may not follow appropriate food safety practices.  

Information adapted from the USDA Food Safety and Inspection Service "Safe Food Handling Fact Sheet"

Content provided by the Joan Karnell Cancer Center

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Christmas with Cancer

For people with cancer and their loved ones, Christmas and the holiday season may not be the “most wonderful time of the year.”

While no one can “skip” the holiday season, it’s important to keep expectations realistic. Let others help out if you need it, save your energy, and most importantly, share your feelings with others.

Oncolink blogger and cancer survivor, Rodney Warner, JD, writes about Christmas with Cancer in this Oncolink blog.

If you are someone with cancer, how will you cope with the holiday season?

Read this transcript of a live webchat from Oncolink called Surviving and Thriving During the Holiday Season for tips on coping with the holidays.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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Life After A Bone Marrow Transplant

Bone marrow transplantation (BMT) treats multiple myeloma, leukemia and lymphoma.

High-dose chemotherapy (and sometimes radiation oncology therapies) can affect the bone marrow. Stem cells in the bone marrow make the cells that carry oxygen through the body, fight infection and help blood clot, A bone marrow transplant replaces the patient’s bone marrow with disease-free bone marrow from a healthy marrow donor. Bone marrow donors are often family members, but may also be unrelated to the patient.

Treatment outcomes for bone marrow transplant have improved over the years. However, there are risks associated with bone marrow transplant. Patients who receive a bone marrow transplant may suffer from a graft-versus-host disease, in which the their immune system attacks the donor marrow cells.   Patient’s immune systems are compromised after such intense chemotherapy and graft-versus-host disease can cause serious complications or even death.

Emotions after a bone marrow transplant

Bone marrow transplants also come with a lot of stress. Full recovery of the immune system may take up to two years, placing a great deal of worry and anxiety on both patients and their families.

While many people might assume the most stressful part of treatment involves the decisions made beforehand and the time spent in hospital, life after a bone marrow transplant presents many challenges.

During the early weeks after leaving the hospital patients still have weakened immune systems and their social contact often needs to be restricted.

Other common complaints include poor sleep, memory problems, poor concentration, lack of appetite, nausea, and less sexual desire. Even after one year, bone marrow transplant recipients often report decreased energy and strength, as well as excessive fatigue.

For many, the hope of a quick return to feeling normal is often transformed into frustration. Bone marrow transplant recipients may also struggle with fears and uncertainly about relapse and their long-term health. As a result, even when physical symptoms improve, anxiety and worry may remain a problem for some time.

This frustration can result in depression as recipients come to terms with new issues in their lives such as increased isolation, loss of control, disruption in their work-life and changes in their role within the family and in relationships.

They may also struggle with guilt over feeling like a burden to others in their post-transplant lives. Prolonged and deepening depression is often a sign that further help is needed and the medical team can often help with the decision to seek help from a therapist and/or start anti-depressant medications.

A good outlook after bone marrow transplantation

The good news is that most bone marrow transplant recipients adjust well to life post-transplant. A key factor in coping is having strong emotional support from loved ones.

Support can include:

• Listening to feelings and anxiety.
• Acknowledging together new limitations of strength and energy.
• Accepting help from others including support groups and professionals.
• Checking in to see how everyone is doing emotionally.
• Encouraging each other to talk about feelings.

Bone marrow transplant recipients also tend to fare better if they have realistic expectations about their recovery. It is important to spend time before the transplant with the medical team discussing the recovery process. Knowing that recovery can be slow is often a protection against disappointment and unnecessary fear.

Finally, it is also crucial to have positive goals to work towards and a reason to want to feel better. While life can often be put on hold by a BMT, hope and determination can give shape and direction to a fuller life post transplant.

When to get help

If anxiety and depression is not addressed, it can affect the physical recovery on a bone marrow transplant recipient. It’s important for people experiencing these feelings to reach out to a professional for help. If interested in speaking with a counselor, please notify a member of you medical team.

Learn more about the bone marrow transplant and stem cell transplant program at the Abramson Cancer Center.

Learn more about the stem cell transplant program at the Joan Karnell Cancer Center.

Learn more about managing cancer treatment side effects.

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Cancer Fighting Cupboard: Sunrise Smoothie

After enjoying all of the tasty treats of the holidays, now is a good time to get back to eating healthy.

Start the morning right with this savory smoothie recipe. Packed with delectable fruits, Sunrise Smoothies are a great way to get a daily dose of fruit and cancer-fighting nutrients. 

Raspberries, one of the central ingredients of the Sunrise Smoothie, has been found to be a source of ellagic acid which scientists say slow the growth of cancerous cells.

Smoothies are also a great choice for patients who have been treated for head-and-neck cancers.

Since these patients may have trouble chewing or swallowing, a smoothie offers a delicious meal and a great way to get essential vitamins. Please note, however, highly acidic citrus fruits such as oranges and lemons should be avoided in smoothies for these patients because they may cause mouth pain.

Ingredients:

• One 15oz. can of 100% juice-packed peaches, drained
• One 15oz. can of 100% juice-packed apricots, drained
• 1/3 cup frozen raspberries
• 1 cup plain non-fat yogurt
• 1 tbsp. ground flaxseed
• 3 oz. tofu*
• 3 ice cubes

Blend and enjoy.

Makes 4 servings

Per serving: 166 calories; 29g carbohydrates, 8g protein; 2g fat; 3.5g fiber

*For tofu, try a brand such as Mori-Nu® This type of tofu does not need to be refrigerated until it is opened.

Source: Suzanne Dixon, MPH, MS, RD, Cancer Nutrition Information, LLC, http://www.cancernutritioninfo.com/


Tips for Smoothie Success

• Some smoothie recipes may need ice cubes; but you can try frozen fruit instead.
• Try your smoothie before adding any sweeteners or flavors… it may already be perfect!
• Take a second to rinse out the blender right after you use it, even if you're planning to wash it later; dried-on fruit makes for slow clean-up.

Content provided by the Joan Karnell Cancer Center

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Advances in HIV Treatment Pose New Risks for Patients

David Henry, MD

David H. Henry, MD, is a medical oncologist, medical director of the Penn HIV oncology program  and vice chair of the department of medicine at Pennsylvania Hospital. Today, December 1 on World AIDS Day, Dr. Henry discusses how treatment for HIV has evolved since its discovery in 1981, and how patients with HIV may be at an increased risk for cancer.

Since its discovery in 1981, treatment for the human immunodeficiency virus or HIV has quickly evolved. In humans, HIV leads to progressive failure of the immune system (immunosuppression), allowing life-threatening opportunistic infections and cancers to thrive.

While for many of us it seems like yesterday this epidemic appeared, most young doctors and nurses in training today have never known a time without HIV.

When it first became apparent HIV was an epidemic, there was no therapy to stop the consequences of profound immunosuppression. Patients rapidly developed full-blown AIDS (acquired immune deficiency syndrome) and died of unusual, opportunistic infections. Back then, I recall losing as many as three patients a month to AIDS. 

When AZT (azidothymidine), the first therapy for AIDS was developed, it began to change the natural course of HIV. But it wasn’t until the more powerful protease inhibitor drugs that were developed in late 1995 that patients were restored to much greater immunity and could avoid opportunistic infections.

Now with at least five classes of antiretroviral therapies, many patients with HIV enjoy a life without opportunistic infections. They have undetectable viral loads and experience significant elevations in their CD4 immune defenses.

However, this major advance in antiretroviral therapy and improvement in longevity has led to a new issue for people with HIV — cancer. 

From the beginning, physicians and researchers knew that profound immunosuppression led to early/frequent development of so-called AIDS-defining cancers:

• Kaposi’s sarcoma
• Non-Hodgkin lymphoma
• Cervical cancer

With highly active antiretroviral therapy, these AIDS-defining cancers are much less frequent, but several non-AIDS-defining cancers have become much more prevalent:

• Anal cancer: One hundred times more likely in the HIV-infected patient
• Liver cancer: Usually associated with co-infection with hepatitis B and/or C
• Lung cancer: By sheer numbers of new cases, may be the greatest problem of all

All of these cancers tend to occur at a younger age than they would in non-HIV-positive people. Anal, hepatic and lung cancer, occur five to 10 years earlier in the HIV-infected population than in those who are not.

Currently, there are no known strategies, drugs or therapies for stable HIV-infected patients that would restore their immunity completely and lower these cancer rates back down to that of the general population.

However, we are developing screening strategies to detect cancer and treat it earlier. 

Smoking cessation and possibly low-dose CT scanning may decrease or catch lung cancer in a more curable stage. Every six to 12 months, imaging of the liver in patients co-infected with hepatitis C and/or B can help identify liver cancer earlier. Routine anal examination and possibly even Pap testing can help discover anal cancer at an earlier, more curable stage.

HIV treatment has certainly come a long way, but vigilance, surveillance, treatment, and better understanding of cancer has become the next major challenge in this ever-present epidemic.

Learn more about the HIV oncology program at Penn Medicine.

Learn more about AIDS research at Penn Medicine.

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Young Friends of the Abramson Cancer Center Fundraiser @ Please Touch Museum in Philadelphia

The Young Friends of the Abramson Cancer Center are having a unique play date on Sunday, December 4, 2011 at Please Touch Museum.

The Young Friends of the Abramson Cancer Center is a dedicated group of men and women under the age of 50 who serve as the next generation of leadership volunteers and donors to Penn’s Abramson Cancer Center.

Young Friends supports the work of young cancer researchers and clinicians, whose brilliant ideas often go unrealized because of a lack in funding. Young Friends provides a forum for becoming more engaged with the mission of the cancer center and staying informed about the latest advances in prevention, detection and treatment of cancer.

The Please Touch Museum in Philadelphia was the first museum in the nation whose target audience is families with children under the age of seven. Its mission is to enrich the lives of children by creating learning opportunities through play, and lays the foundation for a lifetime of learning and cultural awareness.

This event takes place prior to the museum’s opening to the general public at 11 am, and promises to be a less crowded Please Touch experience.

Entertain your children and support a great cause at the same time:

Date: Sunday December 4, 2011
Time: 9 to 11 am
Location: Please Touch Museum, Memorial Hall in Fairmount Park, 4231 Avenue of the Republic, Philadelphia, PA 19131
Cost: $25 per person ($10 tax deductible), which includes admission, parking, carousel rides, and a discount coupon to the café. Children under 1 are free.

Click here to register for this event.

For more information about this event, please contact Michal Greenberg at michalg@upenn.edu or 215-573-2480.

Learn more information about the Young Friends of Abramson Cancer Center.

Make a gift to the Young Friends of the Abramson Cancer Center here.

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Palliative Care Provides Extra Support for Cancer Patients

Barbara Reville, DNP, CRNP is a palliative care nurse practitioner and co-directs the Palliative Care Program at the Hospital of the University of Pennsylvania (HUP) with Michael Ashburn, MD, MPH, a pain medicine specialist and palliative care physician.

Penn Medicine offers consultation with palliative care professionals for hospitalized patients and an outpatient clinic at both the Perelman Center for Advanced Medicine and the Penn Pain Medicine Center. Partners at Penn’s Home Care & Hospice Services provide home-based palliative and hospice care.

Life takes on new meaning when you receive a cancer diagnosis. Doctor appointments, therapy dates and uncomfortable or painful symptoms derail your daily routines of family, work and leisure. Now you have worries about medical decisions and concerns about an uncertain future. Even with top medical care, outstanding nursing support and your family at your side, these are trying times.

Palliative care is a medical specialty focused on relieving pain and other symptoms, and helping patients and families navigate difficult medical decisions. When life gets distressing, palliative care can provide an extra layer of support. Effective symptom management is necessary for many patients coping with serious illness, regardless of the diagnosis or stage of disease. Most hospitals in the United States have a palliative care program, either as a consultation service in the hospital or access to professionals in the outpatient area.

Many people confuse palliative care with hospice care. While they both focus on symptom management, they are not the same. Palliative care supports patients with unacceptable pain, symptoms, or emotional distress at any stage of their illness. While hospice also offers palliative care, it is reserved for individuals with a limited life expectancy who may require advanced symptom management and comprehensive home care.

A Palliative Care Story

Bill, a 67-year-old retired Air Force pilot was vacationing with his wife, Ruth, when his life took a tailspin.

He began to experience difficulty swallowing and gnawing abdominal pain. Back at home, Bill’s doctors found cancer in his pancreas. Bill did not waver when cancer specialists at Penn's comprehensive cancer center, the Abramson Cancer Center recommended an aggressive treatment program of chemotherapy and radiation.

His oncologist prescribed pain medicines, but the pain broke through sapping his appetite and disrupting his sleep. His wife, Ruth, was concerned that at this rate Bill would not be able to tolerate his full treatment.

For extra help, Bill’s doctor referred him to Michael Ashburn, MD and Barbara Reville, DNP, CRNP clinic, at Penn’s Perelman Center for Advanced Medicine. In addition to his pain, the team asked Bill and Ruth about other symptoms and practical needs. As a result of a change in his pain medicine and a referral for home nursing visits, Bill is back on course toward recovery.

Bill and Ruth continue to hope for the best. During discussions with the palliative care professionals, they expressed a desire for complete and honest information from their doctors about Bill’s progress and his options. There may come a time when less treatment and more palliative care are best for Bill. If his symptoms worsen, palliative care professionals can partner with Bill’s oncologist to optimize his medicines and discuss options.

But for now, Bill maintains his recovery plan and is living well.

Learn more about palliative care at Penn Medicine.

Learn more about Penn Home Care & Hospice Services.

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What Happens After You Survive Childhood Cancer?

Melanie Gaffney is a proud childhood cancer survivor, and a contributor to the Focus On Cancer blog.

Today she is cancer-free, but lives with the after effects of her cancer treatments. In addition to being a mom and a wife, she operates a small marketing and graphic design boutique called Melanie Gaffney and also founded Mason’s Mission to raise awareness and funds for Chiari malformation research, a neurological disorder that affects her son. Read more about Melanie here.

Watch for Melanie’s blogs here, and connect with Melanie on Twitter.

For survivors of childhood cancer, the great news is that you survived cancer. But is that the end? Is it really over? Can you stop focusing on your health all the time?

Depending on the type of cancer and the treatments you received, probably not.
There are about 350,000 childhood cancer survivors in the United States. As survivors age, they can experience late effects and long-term medical complications as a result of the treatments that saved their lives.

Today, because of advances in treatment, about 80 percent of children treated for cancer survive five years or more. But the treatments that saved your lives can also cause health problems that may not show up until years later.

In fact, 30 years out, survivors are at more risk of dying from treatment-related illness than from cancer recurrence . Because childhood cancer survivors are living longer, their long-term health and these late effects are issues for most of their lives. Childhood cancer survivors’ aftercare and watchfulness for late effects must be as specialized as the cancer treatments they received as children. Late effects may involve more than one part of the body and range from mild to severe.

The main factors that contribute to possible late side effects include the types of treatment you received, the drugs used in chemotherapy, and the amount and location of radiation and surgeries.

This is why it’s important to find a great primary care physician and a multidisciplinary survivorship program.

Below are some of the effects childhood cancer survivors may experience:

• Bone density issues
• Thyroid problems
• Hearing loss
• Vision problems
• Dental problems
• Lung, liver or kidney problems
• Heart problems
• Fertility issues
• Second cancers
• Emotional issues
• Neurological issues

My Own Survivorship Journey
I didn’t realize I needed a survivorship program until my mid-twenties. I knew I had some physical limitations as a result of my childhood cancer, but I considered them to be minor. I was invincible! I truly believed that since I had beaten cancer, nothing else would ever happen to me. In some sense I felt I had paid my dues and could live like everyone else. This made sense to me as a teenager and sadly even into young adulthood. I ignored any and all signs that my body was telling me that I was, in fact, not invincible.

I was told that fertility and carrying a child may be an issue. Although I am sure other late side effects were probably mentioned when I was younger, these were the only two that I noted. So when I did get pregnant, to say I was totally shocked is an understatement. After the bliss and excitement of finding out I would have a baby came the rush of fear. My cancer came back to haunt me. The moment I remembered I wasn’t like everyone else was when I called my oncologist when most women are calling their obstetrician.

I was referred to the Living Well After Childhood Cancer Survivorship Program at the Abramson Cancer Center. After many tests, pokes and exams I received my first diagnosis of my late-term cancer treatment effects; heart disease (cardiomyopathy) due to chemotherapy, restrictive lung disease due to radiation therapy and an increased risk of breast cancer because of the amount and location of the radiation.

Like many survivors, I also faced some emotional issues like anxiety and dealing with the uncertainty that many cancer survivors deal with - the thought that my cancer may come back.
My life changed when I received my test results. Today, I try to spread knowledge and reach out to childhood cancer survivors about these late side effects. While fundraising for a cure and treatment is important, (without it there wouldn’t be survivors), there also has to be awareness and research to help support those survivors.

I am so excited to be attending the Stupid Cancer Boot Camp in Philadelphia on November. I can’t wait to listen to the speakers, learn more about survivorship and hopefully meet and share stories with other childhood cancer survivors.

The Abramson Cancer Center is part of the LIVESTRONG™ Survivorship Center of Excellence Network, a group of eight Comprehensive Cancer Centers that have been chosen to lead the effort across the country in clinical care and research with cancer survivors of all ages.

Learn more about the Living Well After Childhood Cancer Survivorship Program.

Learn about managing cancer treatment side effects.

Learn more about long-term follow-up guidelines for childhood cancer survivors.

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Joe Frazier Loses Battle with Liver Cancer

On Monday, boxing great Smokin’ Joe Frazier died of liver cancer in his Philadelphia home. The two-time heavyweight champ was 67 years old.

Each year, there are approximately 24,120 new cases of primary liver cancer and bile duct cancer. Of those, about 18,910 people die from these cancers.*

The liver is the largest solid organ in the body and is located on the right side of the abdomen. The liver is responsible for such functions as filtering the blood for excess toxins, helping regulate blood sugar, creating bile for digestion, and creating enzymes responsible for blood clotting.

At Penn Medicine’s Abramson Cancer Center, patients with liver cancer receive care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

There are two main types of liver cancer.

1. Primary liver cancer: Cancer that forms in the tissues of the liver.
2. Secondary liver cancer: Cancer that spreads, or metastasizes, to the liver from another part of the body like the breast, lung, thyroid or other gastrointestinal cancers.

Symptoms of Liver Cancer
In its earliest stages, liver cancer is typically not associated with any symptoms. As the disease progresses, symptoms may include:

• Jaundice or yellowing of the skin and eyes
• Fatigue
• Weight loss without dieting
• Loss of appetite
• Feeling of abdominal fullness or bloating
• Pain and/or discomfort on the right side of the abdomen
• Pain or discomfort that occurs in the right shoulder blade

Treating Liver Cancer
Liver cancer treatment may include:

• Surgery including a partial or hepatic lobectomy, radiofrequency ablation or total hepatectomy and liver transplant. The Abramson Cancer Center’s close collaboration with Penn Medicine’s transplant program provides access to comprehensive medical and surgical care for patients who require a liver transplant. Penn Transplant Institute has performed more than 1,500 liver transplants.
• Radiation therapy including intensity-modulated therapy, proton therapy, stereotactic body radiotherapy, 3-D conformal radiation therapy and volume-modulated arc therapy. Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time. In many cases, radiation therapy is capable of killing all of the cancer cells. Proton therapy at Penn Medicine will soon be used to treat liver cancer, and is currently used to treat recurrent tumors in the digestive tract. Penn Medicine is the only facility in the country treating gastrointestinal cancers in this way.
• Chemotherapy and other biologic therapies including liver-directed therapies such as ethanol injections and chemoembolization of the hepatic artery. Penn Medicine specializes in a team approach to treatment with interdisciplinary care and innovative approaches that use chemotherapy to target tumors prior to surgery. Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body.

The Abramson Cancer Center’s multidisciplinary approach to liver cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Learn more about the gastrointestinal cancer treatment at the Abramson Cancer Center here.

Watch presentations from the Focus On Gastrointestinal Cancers conference here.

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Cancer in Pets

November is National Pet Cancer Awareness month.
Cancer is remarkably similar in its incidence and treatment between humans and companion animals.
Christina Bach, MSW, discusses cancer in pets, signs and symptoms of cancer in pets, and treatment options to discuss with your pet’s veterinarian should your pet have cancer.

Learn more about cancer in pets.

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An Alternative Therapy for Some Breast Cancer Patients

Gary M. Freedman, MD, is an associate professor of radiation oncology at the Perelman School of Medicine and physician at Penn Radiation Oncology.

For more than 25 years, breast-conserving surgery and radiation therapy have been standard alternatives to mastectomy for women with early stage breast cancer. Radiation after a lumpectomy reduces the risk of a recurrence in the breast, and for some women it may also improve survival. The past decade has seen many advances in radiation that aim to preserve the high rates of success, but often must choose between optimizing the treatment delivery and reducing acute or long-term side effects, or reducing cost and convenience of care.

Hypofractionation uses fewer, larger dose radiation treatments (also called fractions) usually given over a shorter time period when compared to conventional radiation fraction sizes.

Hypofractionated radiation has been associated with a reduction in the length of a course of treatment by two to three weeks compared to conventional schedules that can last as long as six to seven weeks. This reduced length of treatment reduces cost to patients and insurance payers, reduces costs of travel or lost days of work to patients, and reduces the inconvenience of daily radiation treatments. This is particularly important in today’s national concern for cutting health care costs.

Hypofractionated whole-breast radiation has been a major subject of research outside of the United States for more than a decade. Randomized trials have been reported from Canada and the United Kingdom that show low breast recurrence rates using hypofractionation with long-term follow up of five to 10 years. In addition, these large studies did not show significant differences in cosmetic appearance of the breast or other negative side effects in women treated with a shorter course of radiation.

Despite the successful outcomes in these randomized trials from Canada and the United Kingdom, there has not been significant adoption of hypofractionation in the United States. The American Society of Radiation Oncology convened a task force of experts to make consensus recommendations. After a review of the available literature and randomized trials, consensus was reached that hypofractionation should be used only for selected patients. This recommendation was based on the many clinical questions that still remain about hypofractionation that are not able to be addressed by the data from the existing randomized trials.

At Penn Medicine, selected women meeting these optimal criteria are being offered the shortened radiation schedule. Current trials could make hypofractionation even more widely accepted for patients with early stage breast cancer. The Radiation Therapy Oncology Group opened a phase III randomized trial in May 2011 that proposes to establish a whole-breast three-week hypofractionation schedule that can be applied to a broader patient population. The study will compare typical whole breast radiation given over four and a half to six and a half weeks to a shorter schedule of only three weeks.

In summary, prospective randomized trials outside of the United States have established the principle that hypofractionation may be used with acceptable low side effects and equally low breast recurrence rates as conventional fractionation. However, for hypofractionation to become more widely applied in the United States, more data are needed about the optimal radiation techniques and limits on patient eligibility. This data may come from a newly opened phase III trial in the RTOG now opening at Penn Medicine and locations across the country. If successful, hypofractionation may be more widely accepted for use in the majority of patients with early stage breast cancer in the United States.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Learn more about radiation therapy for breast cancer at Penn Medicine.

The Abramson Cancer Center (ACC) is pleased to present the Focus on Women's Cancers Conference featuring:

• 20th Life After Breast Cancer
• 10th Focus On Gynecologic Cancers
• Focus On Your Risk of Breast and Ovarian Cancer

Attend Penn Medicine’s Focus On Women’s Cancer Conference

Friday, October 28, 2011
7:30 am to 3:30 pm

Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.


Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

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The Value of Adjuvant and Neoadjuvant Therapy for Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the last of four posts about the latest findings in treating breast cancer.

More News on Aromatase Inhibitors (AIs)
A group of bone health-related studies (Abstracts 516, 517, 518) presented at the 2011 ASCO conference provided some good news on bone loss. The studies showed that postmenopausal breast cancer patients undergoing endocrine therapy (aromatase inhibitors) do not experience an increase in their total number of fractures, despite having some level of bone loss.

Over a period of approximately six years, 5 percent of patients receiving aromatase inhibitors (AIs) suffered fragility fractures, the same percentage as occurred in the control group. Studies also show that exemestane may result in less bone loss than other AIs.

A third set of AI studies (Abstracts 522,523 525) strengthened the data supporting the proposition that women who experience endocrine-related symptoms, specifically arthralgia and bone pain, while taking AIs do have improved treatment efficacy.

Regional vs. Whole Breast Irradiation for Node-Positive Cancer
The controversy regarding the optimal treatment approach for breast cancer with one to three positive nodes has existed for some time. Current treatment guidelines call for regional lymph node irradiation (RNI) for all patients with four or more positive nodes, but have been less clear about the role of RNI in cases involving one to three nodes.

Another trial highlighted at the ACO conference, NCIC-CTG MA.20, bolsters the view that all node-positive breast cancer patients should be considered for RNI.

In this large, intergroup trial, women with positive nodes or high-risk node negative breast cancer were treated with breast-conserving surgery. They were then randomized to receive either standard whole breast irradiation (WBI) or WBI plus RNI. The study demonstrated a clear advantage for the WBI plus RNI group for five year overall and disease-free survival. They did experience modestly increased toxicity, mostly attributable to a slight increase in grade II lymphedema.

Focus on Neoadjuvant Therapy for HER2-Positive Breast Cancer
Neoadjuvant therapy, or therapy that is given before primary cancer treatment, is becoming a standard way to study new approaches to treating breast cancer. Angela DiMichele, MD, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, noted the emphasis on neoadjuvant therapy at the ASCO meeting, citing several studies for women with HER2-positive breast cancer, a group for which there is a growing number of treatment options.

The first (abstracts 505, 507) combined lapatinib and trastuzamab in a neoadjuvant setting without chemotherapy for women with HER2-postive tumors >3cms or >2cms with palpable nodes. The results were positive with an overall pCR of 28 percent and a 40 percent pCR in ER- negative patients and strengthened the evidence for the dual receptor blockade as the new standard of therapy for HER2-positive tumors. The study did have an 8 percent drop out rate resulting from toxicity, primarily diarrhea and acne form rash.

The other studies (abstracts 531, 532) looked at the results of adding chemotherapy to the dual receptor blockade. The first demonstrated a clear advantage to lapatinib and trastuzamab with anthracycline-taxane therapy in terms of pCR, but left unanswered issues as to whether the increased toxicity with chemotherapy is worth the risk and whether the pCR will translate into long-term survival.

Triple-Negative Breast Cancer
While the options for HER2-postive patients continue to expand and improve, the need remains to discover more effective therapies for the 15 percent of patients diagnosed with triple negative breast cancer (TNBC). While considerable attention was focused on TNBC at ASCO 2011, the meeting did not yield significant progress for women with this disease.

Several trials offered data suggesting that basal subtypes of breast cancer might be sensitive to platinum, but much more information is needed to clarify which subgroups of patients and under which circumstances will benefit from this therapy (Abstract 1015). Similar issues apply to the use of agents targeted to the mTOR and PI3K pathways (abstract 1016). The conclusion: For TNBC, a commitment to larger, well-designed trials with integrated, adequately-powered biomarker assessment are needed.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

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How Weight and Hormones Affect Breast Cancer Outcomes

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the third of four posts about the latest findings in treating breast cancer.

BMI and Cancer Outcomes
In recent years, the belief that obese breast cancer patients have worse outcomes has become somewhat entrenched in the cancer community. A North American Breast Cancer Group study presented in 2010 appeared to be confirmed those findings. But just one year later, data presented at ASCO 2011 data (abstracts 513, 514, 515), appears to contradict that belief.

Angela DeMichele, MD, associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, said the combined analysis of five National Cancer Institute studies demonstrate no compelling evidence that obesity, a body mass index (BMI) of 30 or more, compromises breast cancer survival. The studies also show BMI does not affect estrone (the estrogen left after menopause, made primarily by body fat) levels in postmenopausal women.

Despite the discrepancy in the findings, Dr. DeMichele reinforced the need to encourage obese women to lose weight and provide active support to women undergoing hormonal treatment to help them avoid weight gain.

Exemestane Yields Impressive Results in Prevention Study
One of the most noted studies at this year's ASCO meeting was the MAP3 trial (abstract 504), which presented persuasive evidence that the aromatase inhibitor exemestane, has a significant effect in preventing invasive breast cancer in medium to high risk postmenopausal women. The study, released simultaneously in the New England Journal of Medicine, represents a "huge victory for chemoprevention," in the words of the Angela Bradbury, MD, who presented the study at the ASCO meeting.

In this large, multinational study, women who received exemestane had a 65 percent reduction in invasive breast cancer. This is a superior result to the 50 percent reduction seen in studies utilizing tamoxifen and raloxifen.

Over a three-year period, exemestane reduced the incidence of ductal carcinoma in situ and other precancerous conditions, and appeared to reduce the incidence of more aggressive breast cancers in those women who did develop the disease. In addition, the study found that the side effects; hot flashes, insomnia, and arthralgia; were not excessive and generally well tolerated by the study participants. Serious toxicities including fractures, other cancer, osteoporosis and cardiovascular events were not seen in the study participants.

While the MAP3 results are without question important and exciting, some experts question whether healthy women will take a drug that is associated with a spectrum of menopausal type symptoms, even to achieve an important goal of reducing invasive breast cancer. The answer may depend on a variety of factors including:

• Level of individual risk
• Age
• Overall health
• Conversations between women and their doctors as they become aware of this new study and its implications for preventing the second leading cause of cancer deaths in women

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, The Value of Adjuvant and Neoadjuvant Therapy.

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As Surgery for Breast Cancer Evolves, So Do Outcomes

Carla S. Fisher, MD, is an assistant professor of surgery at the Perelman School of Medicine and a breast surgeon. Dr. Fisher sees patients at the Rena Rowan Breast Center.

An article was published earlier this year in the Journal of the American Medical Association (JAMA) that challenged the current way we approach breast cancer treatment and surgery.

The article discusses the results of a randomized clinical trial that took place at many hospitals across the United States. In this trial, breast surgeons found that not every woman with breast cancer that has spread to the lymph nodes may need a full axillary (armpit area) lymph node dissection. As those of us in the medical community examine the results of this study and how they apply to our own patients, it seems appropriate to review a brief history of the evolution of surgery for breast cancer.

The history of the discovery and treatment of breast cancer is rich and one that has been documented back to the ancient Chinese and Egyptian cultures, as far back as 2600 BC. The most common forms of early treatment were medical remedies. In more “modern times,” beginning the 18th century, surgery became more common and well developed as a treatment for breast cancer. Surgery almost always involved removal of the entire breast (mastectomy).

Eventually, removal of all of the axillary lymph nodes and the pectoralis major muscle (one of the main muscles of the chest wall), a radical mastectomy, was also recommended. The surgery was always the same, regardless of the size of the breast cancer or presence of disease in the lymph nodes. This radical procedure, with some minor modifications, was practiced for over 70 years, well into the 20th century. In fact, many women may recall an aunt or grandmother who underwent a radical mastectomy with subsequent deformity of the chest wall.

Surgical techniques continued to become more refined and less morbid for the patient, but it was truly the discovery of the roles of radiation therapy, medical therapies (chemotherapy and endocrine treatment) and early detection (mammography) that propelled breast cancer treatment to where it is today. In the later part of the last century, breast conservation surgery was introduced. This surgery involved the removal of the cancer, without removal of the entire breast, followed by radiation therapy. Additionally, the sentinel lymph node biopsy technique was developed that allowed breast cancer staging without removal of all of the lymph nodes in the armpit area. If the sentinel nodes contained cancer only then would a full axillary dissection (removal) be performed in which the rest of the lymph nodes would be removed.

All of these surgical advances have given women with breast cancer more choices while maintaining or improving cancer care with less side effects and better cosmetic outcomes.

Now in 2011, we have evidence that suggests that even when breast cancer has spread to the axillary lymph nodes, we may not have to remove all of these lymph nodes. The important thing to point out is that while these findings are exciting and may represent a change for some women with breast cancer, the research and findings only apply to SOME women.

Not all women undergoing surgery for breast cancer will fall within the criteria used in this study, specifically women undergoing mastectomies. Younger women and women with certain types of breast cancer also may not qualify for this less aggressive surgery. What this study emphasizes, more than ever, is the importance of an informed discussion between patients, surgeons, medical and radiation oncologists.

At Penn, our multidisciplinary approach to breast cancer care gives us the opportunity to discuss the most up-to-date research, such as this recent publication, and determine how we can best apply it our patients.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:

• 20th Life After Breast Cancer
• 10th Focus On Gynecologic Cancers
• Focus On Your Risk of Breast and Ovarian Cancer

Attend Penn Medicine’s Focus On Women’s Cancer Conference

Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.

Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

 

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Proton Therapy for Lung Cancer Patients at Penn

Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation doses. The result is a better chance for curing cancer with fewer harmful side effects.

Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation while sensitive, healthy lung tissue is better protected from the effects of radiation.

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New Scan Detects Lung Tumors Earlier Than Traditional Scans

Penn's Abramson Cancer Center is hosting a free conference about preventing lung cancer on Friday, October 14.

Register for this free conference, or follow #LungCancerACC on Twitter on Friday, October 14 for live updates from the Focus On Lung Cancer Conference.

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.

Consider these facts:

• In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
• Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
• There are more than 94 million current or former smokers in the U.S.
• Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.

Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

People who smoke, who smoked in the past, or who have been exposed to other people's smoke, as well as those who have worked around materials that increase the risk for lung cancer need to be aware of their lung cancer risk. They should talk to their doctors about their chances of getting lung cancer and the pros and cons of lung cancer screening.

For those who decide in favor of testing, the physicians in Penn Medicine’s Lung Cancer Program are experienced in lung scanning and the latest screening techniques for people at high risk.

For information about smoking cessation programs at Penn Medicine, visit PennMedicine.org/smoking or call 800-789-PENN (7366).

Join Our Lung Cancer Webchat Live from the Focus On Lung Cancer Conference
Lung cancer experts will answer questions about risk, diagnosis and treatment. Submit questions in advance, view and participate in the live webchat and read transcripts after the webchat.
Time: 12:15 PM, EST
Website: OncoLink.org/Webchat

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Should You Be Screened for Lung Cancer?

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.

Consider these facts:

• In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
• Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
• There are more than 94 million current or former smokers in the U.S.
• Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.

Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

People who smoke, who smoked in the past, or who have been exposed to other people's smoke, as well as those who have worked around materials that increase the risk for lung cancer need to be aware of their lung cancer risk. They should talk to their doctors about their chances of getting lung cancer and the pros and cons of lung cancer screening.

For those who decide in favor of testing, the physicians in Penn Medicine’s Lung Cancer Program are experienced in lung scanning and the latest screening techniques for people at high risk.

For information about smoking cessation programs at Penn Medicine, visit PennMedicine.org/smoking or call 800-789-PENN (7366).

Learn about proton therapy for lung cancer.

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OncoLink Launches New Cancer Risk Assessment Tool

Carolyn Vachani, RN, MSN, AOCN, is a nurse educator for OncoLink®, an award-winning cancer information website sponsored by Penn’s Abramson Cancer Center. She is an oncology advanced practice nurse and has worked in the areas of medical hematology and oncology, bone marrow transplant, clinical research, radiation therapy and staff development.

Carolyn Vachani, RN, MSN, AOCN

In my time as an oncology nurse, I have sat with many families who were processing a loved one’s new cancer diagnosis. No matter the scenario, the questions are similar:

• How did this happen?
• What caused this?
• What do I do now?

People want to know their own cancer risk.

Friends and family rally around the patient, helping with meals, transportation and childcare. At the same time, many are also thinking: “Why my friend and not me?” It is only natural to think about one’s own mortality when a friend is faced with a cancer diagnosis.

What’s My Risk? is a comprehensive cancer risk tool at OncoLink designed to help individuals learn about the factors that determine their personal cancer risk and what they can do to decrease that risk. By completing a detailed questionnaire about their habits, lifestyle and health history, the program identifies their risk for cancer by creating a detailed report. The report includes information about each risk factor, how it affects cancer risk and resources to change those factors that can be changed.

Some good can come from a family member or friend being diagnosed with cancer. In the medical community, it is called a “teachable moment.” It is that time when a person is so affected by their loved one’s diagnosis that they vow, whether publicly or privately, to make changes in their life to reduce their risk of being in a similar situation. Maybe they’ll start exercising, make a diet change or quit smoking. So at this moment in time when they are most open to making changes, how do they know where to start? Do they really know what habits increase their cancer risk or how to go about changing them?

What’s My Risk? is a “teachable moment;” a chance to live healthier and reduce cancer risk.

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Understanding the Biology of Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the second of four posts about the latest findings in treating breast cancer. 

One of the larger trends in cancer treatment, especially breast cancer treatment, is the increasing ability to identify biologic subtypes of the disease and the need for better prognostic biomarkers, or biomarkers that provide information regarding outcome without regard for therapy.

Angela DeMichele, MD, MSCE

At the 2011 ASCO conference, Angela DiMichele, MD, MSCE, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, talked about the important role biology plays in identifying these markers. As co-program leader of the Abramson Cancer Center's National Cancer Institute (NCI)-approved breast cancer program, she discussed one such marker, Ki-67, and intrinsic genetic subtypes.

Two studies (Abstracts 500 and 501) provide support for the validity of Ki-67 as a means of identifying highly proliferative tumors and those that are more likely to respond to specific chemotherapy regimens. Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. This characteristic makes Ki-67 a good tumor marker. This test is done on a sample of tumor tissue, to help predict your prognosis.

Many studies have been done to determine Ki-67's value as a tumor marker test. Researchers agree that high levels of Ki-67 indicate an aggressive tumor and predict a poor prognosis and tumors that tested positive with high levels of Ki-67, have a higher risk of recurrence.

Perhaps more intriguing is the emergence of intrinsic subtypes of breast cancer. Gene expression studies have identified several distinct breast cancer subtypes. The value of this information is less clear, but understanding the specific biologic characteristics that influence these subtypes may help determine which patients will respond to which therapies.

Cancer researchers now understand that breast cancer is a spectrum of diseases, ranging from those that are more endocrine driven to those that are more chemosensitive. These findings reinforce the need for accurate molecular profiling for all breast cancer patients.

OncotypeDX has become a standard means for molecular profiling and guiding breast cancer treatment decisions, but another, potentially even more comprehensive tool is on the horizon. PAM-50 screens for 50 genes and is potentially more sensitive, but is not yet clinically available. Further studies are needed to validate its use.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, How Weight and Hormones Affect Breast Cancer Outcomes.

Read More