MBC Awareness Day - The Darkside of the Pink Ribbon-Fest

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Today, October 13th, is Metastatic Breast Cancer Awareness Day. YES, this select subset of Journeyers get one day out of the entire Pinktober-fest. One day out out of 31, to bring attention to that form of breast cancer that claims the lives of women & men at an average rate of 40,000 per year. That significant statistic is only for the U.S. Approximately 470,000 die each year world-wide. Such little attention has, historically, been given to MBC - either in "awareness" or in research. MBC is the dark underside of the Pink Ribbon. I do not often paraphrase Stalin, actually, this is my first time, but it seems fitting. Sadly, in the world of MBC, one death is a tragedy but thousands seem to be merely a statistic.

I wrote the following in February 2010 - just over 6 months after my initial diagnosis; while I was still in the throws of multiple surgeries; and while I was still in the midst of embracing my own cancer journey. This was in response to the dearth of information and mis-information that I was having to contend with as I groped my way along a well-chartered, but equally mystifying path. It seemed apropos to reprint again, as I continue to stumble along the routeway of MBC.

Please to Meet You...Can You Guess My Game?

You pay homage to me
With candlelight's,
With relays, and
Pale pink parades.
You go through these motions, notions
and emotions half-veiled and dazed.
Caring, yet not comprehending the dark nature of my true game.

I have marched on,
I have latched on,
I live due to the choices you have made.
You're dumb-founded and scared, and
Emboldened and brazen.
And I enjoy this pink badge of honor,
Celebrating the carnage left in my wake.
Yet you don't seem to understand when you meet me,
Thou you flippantly market my game.

You clamor to the life I've taken -
Fear gripping you like a vise,
Yet celebrating with ribbons and vigils
And solemn events to light up the night.
Yet I still seize, clutch, and penetrate,
Creating breastless creatures with the disease I rake.
And in response you raise your banners and tie your pink laces,
Feigning a civilized calm, within the din of despair,
Yielding and railing at the call of my name.

I enjoy an enviable market niche,
A public relations dream with a broad reach.
I bring many persons together
To walk,
To share,
To cry, and
To prescribe.
Together you'll meet me, step-to defeat me and fight,
While still shunning from the meaning of the game that I play,
For the "greater purpose" you cling to me me, giving life to my name.

I'm embraced,
I'm battled,
I'm run for, and against.
I raise warriors in pink,
I raze survivors inside and out.
You speak awareness of who I am,
Yet I'm still the ever uninvited guest.
You know me, but you choose not to see,
Past the Madison Avenue glitz; and
In the whispers of your fears, my name is endorsed on your lips.

You make me t-shirts and teddy bears,
Coffee cups and pins
You celebrate my name,
In the hopes that YOU will win?
I'm on bracelets and billboards,
T.V. ads and magazines.
You use me to bond women together,
Through hats, key chains and I.V. scenes.
You want to be rid of me, wrench me from your breast,
While still elevating my name like some personal test.

You breathe and drink me, in
The chemicals you create.
The ones that both heal and do harm.
You willingly open your body to my sin.
Your lust for luxuries simply invites me in.
Through cosmetics,
Beauty creams,
Lipsticks,
Shampoo,
Hair color,
Deodorants, and
Perfumes.
You gulp me down in plastic bottles.
Swallow me hungrily in pills.
You ingest me in the foods you eat,
And still,
You come gripped with shock and dismay,
And curse when you greet me,
Still stoically refusing to take personal ownership of my game!

I bring sorrow,
You bring hope -
And wrap yourself in courage desperately borrowed.
I bring profit -
Greedily spawned from your daughters,
Yet you say you know me, with no knowledge.
And you keep coming to me in droves,
Throwing away your intuition,
Innate sense and well being, no longer trusting your own.
You claw at and cling to the coattails of Big Pharma,
Opening your veins up to the corporate dogma.
Good patients burn flesh and sear mind under the guise of a pink banner,
And savor Red Devil cocktails, while
Quality of life becomes nothing but face-book banter, of
Buzz words, fly-bys, statistics, wigs, and trials,
As you uncomfortably nestle blindly in my surreal guile.

Am I nature,
Am I man-made, or
A product of freakish DNA?
You don't know,
You don't ask,
You lock-step on.
You want only to walk on the pink runway,
Fear as your drum.
All the while feeling empowered,
Rallying with the pink-media monster, who
Romanticizes the call,
To join the growing roster forged in my name,
And trust that I am very pleased to shroud you in the nature of my game!

- TCShanker (aka "TC")
February, 2010

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To gain greater insight into the MBC Community; the grass roots movements to educate the general as well the Pink-Public as to MBC; and to make this deadly aspect of breast cancer a priority in funding & research, please explore the following resources. Thank you for taking the time this October 13th, and beyond.

Metavivor.Org
http://www.metavivor.org/index.html

From support groups to funding vital research, our programs sustain the power of hope. Passionately committed patients ourselves, we rally public attention to the urgent needs of the metastatic breast cancer (MBC) community, help patients find strength through support and purpose, and make EVER dollar count as we work with researchers to regain longevity with quality of life.


Metastatic Breast Cancer Network
http://mbcn.org/

MBCN is a national, independent, nonprofit, patient advocacy group dedicated to the unique concerns of the women and men living with metastatic breast cancer . We strive to help those living with stage IV breast cancer be their own best advocate through providing education and information on treatments and coping with the disease.
 

National Foundation for Cancer Research

http://www.nfcr.org/metastatic-breast-cancer-research

Even after successful removal of a primary tumor, cancer patients still live under the constant fear that a few cancer cells have escaped the surgery, and that these cells may eventually become secondary tumors in other locations of the body. Presently, there has been insufficient research on the root cause of metastasis, which means that there are no effective medical strategies to prevent or stop cancer once it has spread. Although chemotherapy drugs are used to inhibit the cancer metastasis, this form of treatment often leads to debilitating side effects which diminish the quality of life for patients and their families.

There is an urgent need f or better methods to prevent and treat metastasis. Due to the complex nature of this aspect of cancer, extensive research collaboration among scientists is essential to tackle this problem. Critical as it is, research funding in this field is severely limited. Of the $6.2 billion dollars allocated to the National Cancer Institute for cancer research, less than 1% of that budget focuses on research trying to understand the fundamental mechanisms of cancer metastasis.

The metastasis of cancer cells is the greatest cause of lethality from tumors. Despite this fact, metastasis remains a relatively understudied area with a corresponding lack of understanding of the metastatic process. The research presented above has already provided new insights into the causes and mechanisms of cancer cell metastasis.


 

Sitting "Shiva" for One, and All of the 41,000

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There are inevitable realities that we must embrace as part of our membership in the human experience: birth, disease and death. It is within the intervening moments of these realities that we try to distinguish ourselves; define our lives; create some happiness; and for better or worse, beget a personal legacy.

In between birth and death, is "disease." Not all of us will be directly stricken. But disease will touch all of our lives in some way. Then there are those of us who find imposed upon our reality, the learning to live with chronic disease. That can be tricky. An inevitable component to learning to live with a chronic disease is the "looking over the shoulder" to see if the disease is catching up. For most of us living with metastatic  breast cancer, it is fairly inevitable that at some point our MBC will indeed catch up with us. But even the inevitable can leave you feeling like you have been kicked in the gut.

This past week has been a gut kicker.

Essentially, this week I have been sitting "blog-os-phere" shiva for a fellow metastatic breast cancer journeyer. A brilliant blogger/essayist. An accomplished individual in all her own rights - a woman who did distinguish herself; defined a life for her and her husband and family; who from all sources created happiness not only for herself but for those fortunate to be within her sphere; and who bestowed a legacy that is being cherished by so many that she touched. A beautiful soul that left this pedestrian journey to explore a new path on a different plane.

The Cancer Culture Chronicles: Rachel Cheetham Moro 1970-2012

cancerculturenow.blogspot.com
http://cancerculturenow.blogspot.com/2012/02/rachel-cheetham-moro-1970-2012.html

Shiva is a an integral stage in the mourning process. The first stage of mourning is aninut, or "[intense] mourning." An onen (a person in aninut) is considered to be in a state of total shock and disorientation. Initially, when I heard the news of Rachel's passing, I felt dizzy and frozen at the same time. The room was spinning, but my breathing was stifled by the emotional vertigo that gripped me. Then there was this eruption of emotion, punctuated by a deep growling sob. The sound was coming from me? How could this "force" that is ...  had been, Rachel been extinguished?

Rachel's last post on CancerCultureChronicles, on January 19, 2012,included her usual snarky, intelligent and challenging style: "...Given Komen's relentless pursuit of the almighty dollar, and its almost megalomaniacal status as the world's leading breast cancer organization, is it not time for Komen to be more transparent about where it's future priorities lie and how it evaluates it's success?

Don't we, as the donating public, deserve better?  Come on Komen, what's your plan for the next $2 billion, and if you are no longer for the cure, then what are you for?http://cancerculturenow.blogspot.com/2012/01/for-cure-or-not.html

Aninut is immediately followed by avelut ("mourning").  Avelut itself consists of three distinct periods.The first stage of avelut, and the most commonly known, is shiva (Hebrew: שבעה ; "seven"), a week-long period of grief and mourning. Observance of shiva is referred to, at least by western Jews, as "sitting shiva". It is considered a great mitzvah (commandment) of kindness and compassion to pay a home visit to the mourners.

Rachel Cheetham Moro passed away, left us, departed ... died on February 6, 2012. I am not in the mood for euphemisms. The reality of Rachel living with metastatic breast cancer, coupled with the life-sucking adjuvant treatment that she endured was that, more likely than not, the inevitable would catch up with her. It did. It sucks. The loss is palpable. I am angry.

So many have been writing about their memories and feelings for Rachel. Many and most are screaming their outrage of the needlessness of Rachel's death. Rachel had not been doing well. She shared that with us. Never in a whiny, poor-me fashion. No. Her frustration and fears were expressed with humor, challenging those who read her well-crafted essays, to dare to feel sorry for her. Rachel's strength and joyful audacity was evident even through the medium of blogging.

I never had the opportunity to sit and share face-to-face conversation, and wine, with Rachel. I will never get that opportunity, at least on this plane. It is my loss.

This past week, however, I have re-read her blog entries. I have re-read her comments over the last 14 months to my blog entries, as well as her Facebook postings. I have visited her posthumous blog, sharing in the pictures and chronicles (no bad pun intended) of her life, preserved in the memories of her husband, Anthony (whom she referred to as "Beloved") and her family.  I have spent this week of avelut sitting shiva and thinking about and remembering Rachel as I knew her. Contemplating how she touched my life, and what meaning she brought to our shared experiences.

Rachel was a light that I looked to each week. Especially when I was re-staged with MBC this past summer. We both had a propensity toward snarkiness and irreverence (and at times, downright hostility) toward the industrial machine that dominates breast cancer research - Komen-led, and vacuously marketed by pink banner-cutsie profit-seeking retailers. I could relate to her frustration and shared her call to change the scripted conversation that has stymied the "breast cancer conversation" these last 30 to 50 years.

My "virtual" connection with Rachel was bittersweet, however. Rachel had been living with MBC for several years when our blogging paths crossed. She had originally been diagnosed with breast cancer in 2004, and three (or so?) years later re-staged with MBC. For me, Rachel was living with "our" disease a few steps ahead of me. To witness the progression of her disease was like having the advantage of a cruel "crystal ball." Many times I wanted to through a hissy-blog-fit with Rachel and beg her to stop the chemo. Just stop! The ravages of the treatment are killing you! I could never disrespect her, or anyone else, with my opinionated prejudices. I kept my own counsel. But I am angry now. Not at Rachel and her choices. She chose the color of her journey, and bravely lived through its ruthless intentions with such enviable vitality.



Rachel

No, I am angry that living with metastastic breast cancer, Rachel - and yes, me and others like us, have so few real choices. That is not to imply that all those living with non-stage IV breast cancer are enjoying a smorgasboard of options. They are most definitely not. The prevailing lack of attention given to advanced breast cancer - by the media, by the medical community-at-large, by the monolithic entities, and yes you Susan G. f-ing Komen Foundation, make you all complicitous in the death of Rachel - who has now joined her path as one of the 41,000.  

This inevitable reality, although well-known but equally well-ignored, is a real gut-kicker.

Here is to you Rachel. You are still a light, a force to be reckoned with. You nurtured a legacy that will keep you present with us. You, and the 41,000, give voice to the dire need for change both in the breast cancer conversation and in the current potentates in the breast cancer industry. We must find a way for not only the voices of the 41,000 to be heard, but to be the catalyst of live-saving change.

Hoo Roo and Cheers, Rachel! 

On October 10th, METAvivor Research and Support launched its 30% for 30% Campaign in a concerted effort to improve longevity and quality of life for persons with metastatic breast cancer (MBC). The concept is simple: Since thirty percent of all breast cancer patients develop MBC -- a fatal condition, then 30% of breast cancer research funds and 30% of breast cancer support activities should be dedicated to MBC. At present, only 2% of breast cancer research funds go toward MBC research and support for the disease is rare.

"People do not realize that metastatic breast cancer is widespread and deadly, and that it strikes on whim and takes 41,000 American lives every year. Survivors think they are safe because they are 5 years out ... or were diagnosed early ... or were told they are 'cured', but MBC plays by its own rules." says METAvivor President, CJ (Dian) Corneliussen-James. "People diagnosed at stage 0 as well as 30-year survivors can and do metastasize. You feel great one day and the next day learn you have MBC. Your life can change that fast." http://www.metavivor.org/METjoin_30430.php

EXCLUSIVE to BooBeeTrap..."Ms. Brinker Bares All on the Latest Battle of Political Agendas: Profit vs Women's Health (...not again!)"

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STOP the PRESS!!!!

With all the online flurry about Susan G. Komen, I felt I could not add anything original to the current virulent discourse. Then I was given the unique opportunity to interview Ms. Nancy Brinker, founder of Susan G. Komen. What a coup for an Anti-Pink Blogging Grumbler such as myself. Ms. Brinker would only allow seven (7) select questions in this exclusive interview. She wanted to to tap dance around, justify, put to rest all the speculation circling regarding Susan G. Komen's recent controversial decision to pull funding for breast cancer screening, medical referrals and mammograms for women who utilize the services of Planned Parenthood. A "set-the-record straight" tete-a-tete. Despite the sensitive nature of this topic, Ms. Brinker  PROMISEd ME that she would answer honestly on all accounts. A one-time only exclusive for all you Boo-Bee Trap fans!

All right it only took place in my head, and I didn't draft the questions - Nancy from Nancy's Point http://nancyspoint.com/susan-g-komen-for-the-cure-planned-parenthood-a-tidal-wave/ was the author of the insightful questions in bold, below. But wouldn't it have been refreshing - a candid discussion with Nancy G. Brinker!?

This is how it played out in my head:

1. Do you genuinely care about the health of all women? 

Old adage, "actions speak louder than words" - because of SGK's actions in this instance and in the way we have historically and consciously decided not to address issues, like metastatic breast cancer (you know...that loser cancer cause) I would think you already know the answer to this question....The answer is a resounding NO, not ALL women -- only the vocal right wing conservative non-minority women. You know, the ones that can actually afford to pay, or have comprehensive health care that pays, for breast cancer screening. And, of course those women that Rep. Stearn tell me are the "good women." He's been compling a list.

2. When did caving to political pressure from any source become acceptable for an organization like Komen, the self-proclaimed world leader in the fight against breast cancer?

It  all became acceptable when my little "nonprofit" greedily took money from companies that perpetuate cancer (by the wide spread commercial use of known carcinogens) -- it is a lucrative reciprocal business relationship after all. This discriminating myopia was reinforced when we got away with requisitioning a product, for profit and marketed to women, containing identified hormone disruptors. It was a brilliant business decision as it ensures our longevity as a necessary organization. BTW, I brought you a complimentary bottle of PROMISE ME, since I was informed prior to our interview that you are a stage IV cancer patient. Honestly honey, what harm can a little PROMISE ME behind the ears do to you in your situation? And make sure to share it with your daughters - if SGK is going to thrive through the 21st Century we need the next-generation.

3. Unfortunately, I have to ask, is this really about breast cancer, or is it more about pro-choice vs pro-life agendas and possible contributions Komen may or may not receive if they do not pull funds from Planned Parenthood?

It was an economy of scales decision: the extreme right-wing conservative political faction in this country hold more wealth than the minority/women population served by that sketchy organization, Planned Parenthood. SGK may well alienate the "liberal" financial base that is outraged by the burden and impact of our decision, but SGK will still be able to meet targeted fundraising goals through our now public support of these new BFFs. There is a great surge in the country to undermine efforts in making health care affordable and accessible to all, SGK does not want to be behind the curve on this surge.

4. Since many women rely on Planned Parenthood for all of their health care needs, do you really want to send the message you don’t care about them? What if they die from an undetected cancer? Don’t their lives matter?

They will be dead, duh! Our lawyers have advised us that since we are not obligated to provide this service. We are a nonprofit philanthropic organization so we don't need to do everything for everyone. Well, our lawyers advised that, because of our 501(C)(3)status, the surviving families of THOSE dead women will not have any legal causation for a wrongful death suit. So, in a nutshell, since there is no liability on our end...NO...they are not even a blip on our spreadsheets! Then there is the consideration of our new BFFs on the right. They showed SGK's board that statistically PP's target population have low voter turn outs, so they don't calculate on their spreadsheets either. Our messages is: this decision is a win-win for us and our well-heeled BFFs. Besides, I have truly exaggerated the impact that SGK has had in deterring breast cancer deaths over the last 30 years. Bottom-line (don't you just love that term!) my obligation is to our financial stake-holders...oops, maybe I shouldn't have said that, that may be in violation of SGK's by-laws as a 501(C)(3). You will delete that last statement, right?

5.  And why the sudden change of heart? Komen has been partnering with Planned Parenthood since 2005. That’s seven years. This “investigation” came to the forefront in 2011. Grants from Komen totaled around $680,000 last year and $580,000 the year before, allowing Planned Parenthood to provide breast cancer screenings and other breast-health guidance services to more women in need at 19 of its affiliates.

Ms. Handel - our new, very out-spoken, vociferously anti-choice crusader, was hired 18 months ago. Part of our employment contract with her was that we would indeed make strides to transition away from our prior 6 year support of screening, referrals, etc. to THAT population served, largely in-part by Planned Parenthood. This was a real stickler for Ms. Handel. Well, Ms. Handel is a real go-getter and rallied the dormant politicized myopic agendas of our other board members and took care of business faster than we could all imagine. Securing her for SGK has been a real feather in our philanthropic cap.

6. Shouldn’t this be something Komen is proud of, not halting?

Despite what I said to the prior question (#4) - because I really don't have any qualms being inconsistent or contradictory, SGK continues to be proud of the significant inroads we have made over the last 30 years in striking a significant blow to the prevention and cure of breast cancer...even if over 40,000 women die of MBC every year in this country. Interestingly, no matter how many 3-day walks we hold, that number really has not significantly changed in the 30 years we have been in existence! I need to talk to the board about stepping up production of  BPA filled plastic pink water bottles...but I digress. Well, I am proud to be fulfilling the promise I made to my sister on her deathbed...um...that only a SELECT group of women who align with my political & religious ideologies will be afforded access to potentially life-saving health care! Between you and me, it is a good thing Susan is not here, she would so rip me a new one right now!

7.  How do you justify eliminating funds to support Planned Parenthood while also proclaiming commitment to your mission?

I am proud to be fulfilling the promise I made to my sister on her deathbed...um...that only a select group of women who align with my political & religious ideologies will be afforded access to potentially life-saving health care! Oh cr*p...did I just say that out loud, twice? This interview is so over - when you have this much Botox in your face, it really is hard to pontificate for long periods. Don't forget your PROMISE ME!

Friday the 13th ... Nothing New

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My last post was about the redundancy of restarting; resolutions; and renewals.

For the last two weeks, I have been the poster-child for redundancy. The December before my initial diagnosis I was laid up for a few weeks with a bout of pneumonia. That was December 2008. December 2009 I found myself plagued again with pneumonia - a slightly worse case. December 2010, I was in bed for over 3 weeks with pneumonia. I could not move. I could not read. I could not watch movies. All I could do was stare out the window and doze intermittently between fever-induced hallucinations.

December 2011 came and squeaked by and I thought...YAY! Dodged the pneumonia bullet this December.

January 3rd I was inflicted again. What is with my lungs?!

I have managed to stay out of bed this round. In fact, I haven't even been able to sleep for nearly 8 nights. I finally got an ozone treatment on Wednesday and had my first night sleep since January 3. (Thank you Dr. John) I have been walking. Not talking...much. And keeping up...sort of.

I have found myself bogged down with lethargy. I am so frickin' tired! All the time. Everything is an effort. Including, but not limited to, breathing.

Through this, I have been acutely aware of how I am so inundated with cancer. I am not referring to my body (though with cancer wheedling its way through my lymphatic system...) but I refer to my "world."

I reconnect with an old dear friend, and I find that she has lost a friend to breast cancer; and has just had another diagnosed at stage I.

I check my morning emails and find the journal of a colleague who is about to undergo a protocol of radiation (and anyone who has followed BooBeeTrap knows my personal feelings about conventional treatments) ... and I bite back my opinions. Treatment paths are personal paths to be respected...so I manage to curtail my tourette-like comments to myself.

I pick up our local newspaper and read an announcement about a neighborhood garage sale to benefit a single mother who is having difficulty keeping up with her bills while she is going through debilitating adjuvant treatment.

I turn on the news and barraged with extended ads for SGK's 3-day run. (OY! this helps, how?...but I digress to my usual pink-questioning...)

Redundancy. Sad. Heartrending. Overwhelming. Life-cycle. Predictable. Redundancy. Even this post.

"The Harsh Reality" of Pink (?)

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I am a devotee of many of my breast cancer "colleagues" blogs. Fabulous, courageous, funny, warm, honest women whom I have never met personally. But who have provided me with a window to share my journey; as well as varying perspectives to color and inform my own path.

In viewing a link to another post  via "Desiderdata" http://desideratajourney.blogspot.com/ today, I came across a hauntingly beautiful and profound black and white retrospective, lovingly documented by a husband, of his wife's breast cancer journey.

It is a must-see: http://mywifesfightwithbreastcancer.com/. I set it to "slide-show" and was so captivated I found myself on the fourth loop before I could tear myself away. And then I found myself emotionally staggered. This is not Pink.This is the reality

It is not necessarily the battle with cancer that we (the collective "we") are fighting. Rather it is the battle with the treatment. If the cancer doesn't kill "us" the treatment most certainly will.

I knew this. But somehow the harsh reality of this obvious fact hit me in the chest today - literally. Treatment has been the most contentious battle-front, for me, since my BC-Day -- July 8, 2009.

It is not the dying of cancer that gives me night terrors. It is the living as a cancer patient that sends me physiologically reeling.

Institute of Medicine ... "Pinkwashed"?

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According to the IOM Report released on December 7, 2011 (see link below), "[m]ore than 230,000 new cases of breast cancer are expected to be diagnosed in the United States in 2011." As such, the following summary by BCAction is significant on a number of levels. For me personally, it amplifies the frustration that I contend with in not knowing / understanding the hows and whys I sit here today with metastatic breast cancer - as I, like so many women have no identifiable risk factors. No "life-style" risk factors what-so-ever; and at the initial stages of my diagnosis over 2 years ago, I went through genetic testing (I needed to know for my 3 children) just to confirm that my DNA was not predisposed. Nothing.

Generally, what is currently not going on at the SABCS, informs me that either the medical community is -- at best, still stymied (by the breast cancer industry, maybe?) or at worst, not genuinely interested, in making any real head way in proactively identifying and addressing the true environmental causes for the increase in incidences of breast cancer - especially in developed countries.

Feeding the personal and general concerns is that this Symposium is reportedly being funded, solely by...Susan G. Komen.

http://www.iom.edu/Reports/2011/Breast-Cancer-and-the-Environment-A-Life-Course-Approach.aspx

For immediate release
December 7th, 2011
Contact: Angela Wall, Communications Manager (415) 243-9301 x16 awall@bcaction.org

SAN FRANCISCO, CA–Breast Cancer Action (BCAction), the respected watchdog of the breast cancer movement, responded with disappointment to the Institute of Medicine (IOM) report on Breast Cancer and the Environment: A Life Course Approach released today at the San Antonio Breast Cancer Symposium (SABCS).

The IOM was asked to review the current evidence on breast cancer and the environment, consider gene-environment interactions, review challenges in investigating environmental contributions to breast cancer, explore evidence-based actions that women might take to reduce their risk and recommend research in all of these areas.

“The IOM Report fails to turn the tide on this epidemic because it misses some important opportunities to implement real changes” said Breast Cancer Action’s Executive Director Karuna Jaggar, commenting from SABCS. “They too broadly define the environment as all factors not directly inherited through DNA which includes anything from genetic changes to tissue, to stress, to lifestyle choices and changes in abdominal fat rather than the chemicals we are all exposed to in our everyday lives.”

Breast Cancer Action is deeply disappointed in the report which fails to advance research on breast cancer and the environment and shed light on the 70% of breast cancer diagnoses for which there are no known risk factors. “The report recommendations for women merely rehash the little bit we already know about lifestyle and breast cancer and miss an opportunity to focus on relatively unknown areas of the environment,” said Jaggar.

The report correctly identifies methodological challenges in data collection establishing links between environmental factors and breast cancer. “In medical science, the gold standard of evidence is random controlled experiments on humans; however, as the report rightly points out conducting random controlled experiments on the effect of toxins on women would be immoral and impermissible. We must find alternatives that enable us to take action.” Jaggar stated that “we need to adopt the gold standard of prevention and that’s the precautionary principle because waiting for absolute proof is killing us. Instead, the IOM shrugged the burden of prevention onto women’s lifestyle choices.”

IOM committee member Dr. Robert A. Hiatt stated at SABCS that if women follow the recommendations of the IOM report “we don’t even know whether they will actually reduce their risk.”Jaggar adamantly argued that “we don’t need reports that dink around with lifestyle choices—more exercise, less alcohol, avoiding excess weight, don’t smoke, etc.—which have at best an extremely small role in reducing breast cancer risk and which fail to acknowledge that not all women have equal access to healthy lifestyle choices. We need to apply precautionary principles that stop cancer before it starts.”

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Breast Cancer Action (www.bcaction.org)—a national non-profit education and advocacy organization refuses to accept funding from pharmaceutical companies or any other organizations that profit from or contribute to the breast cancer epidemic.

CancerCultrChronicle
Posted December 8, 2011 at 10:20 am | Permalink

Too Much Pink Ms. Brinker?...Yes, yes there is!

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Anyone who has read my blog knows that I am a card-burning anti-pink rabble-rouser. Or in Ms. Brinker's [founder & CEO of Susan G. Komen] opinion...a grumbler. Nancy'sPoint - a blog that I follow and enjoy, insightfully scrutinized the following OP-Ed by, for, on behalf of Ms. Brinker - wherein Ms. Brinker defends the mission of SGK against plebeians like myself.

I am not going to try and compete with Nancy's dissection. [Check out Nancy'sPoint: http://nancyspoint.com/rumblings-grumblings-my-response-to-ms-brinker/.] I was so enraged, however, when I read Ms. Brinker's OP-ED piece myself, I just couldn't sit quietly. My own opinions and fingers started churning. I share Ms. Brinker's OP-ED in its entirety below.

First impression for the uninitiated [not meant to be derogatory, but only to categorize those who enjoy an envious life beyond researching anything and everything related to breast cancer] may be..hey, SGK sounds like they are on the front line for those living with breast cancer...PINK ON! Then, there is the fact-check. And Ms. Brinker's defenses, in my opinion, crumble. I share my opinion and my two cents in CAPS at the most egregious of her statements, below. I have also included  all of the posted comments to Ms. Brinker's OP-ED. They are articulate, respectful, and spot-on. They challenge the unsupported assertions of Ms. Brinker brilliantly, and made me proud to be an ANTI-PINK RABBLE-ROUSING GRUMBLING PLEBE.

Another View: Too much pink? Not while breast cancer still kills

Special to The [Sacramento] Bee

OPINION - Published Sunday, Oct. 30, 2011

Nancy G. Brinker, former ambassador to Hungary, is founder and CEO, Susan G. Komen for the Cure. She is responding to the Oct. 23 article by Francesca Lyman in California Forum, "Pink Inc. has many starting to see red."

October is Breast Cancer Awareness Month, and every year at this time we hear grumblings about pink, the color of the breast cancer movement.

"There's too much pink." "We have enough awareness." "Where is the money going?"

When a Portland woman is living in her car because she can't afford her cancer treatment; when a Chicago woman has to choose between paying bus fare to treatment or buying food for her family; and when treatments for metastatic breast cancer are often more debilitating than the disease itself, then there is not too much pink during October. We'd argue there's not enough.

MS. BRINKER, YOU NEGLECT TO SHARE THE LACK OF FUNDING THAT SGK ITSELF DIRECTS TOWARD METASTATIC BREAST CANCER RESEARCH & TREATMENT. YOU GLOSS OVER THE SAD FACT THAT SGK SOLELY FOCUSES ON EARLY DETECTION...WHICH DOES NOT NECESSARILY "SAVE LIVES." THE VERY TRAGIC IRONY IS THAT SUSAN G. KOMEN DIED FROM METASTATIC BREAST CANCER. SEE ALSO... http://boo-bee-trap.blogspot.com/2011/10/peaking-behind-pink-curtain.html

For the skeptics out there, we'd invite you to take a few minutes to learn what the pink is actually doing. You might be surprised to learn that 84 cents of every dollar spent by Susan G. Komen for the Cure over the past five years has gone to cutting-edge research, to community programs that get women into and through cancer treatment, to advocacy programs that preserved cancer funding in 19 states, and to things that mean a lot when you're sick, like wigs, groceries, co-pays and, hopefully, an end to having to choose between feeding your family and going to the doctor's office.

FOR THE "PINK BELIEVERS" OUT THERE, SGK HAS BEEN IN EXISTENCE FOR 32 YEARS, WHICH BEGS THE QUESTION: WHY DID SGK ONLY START DIRECTING FUNDING  TO "CUTTING-EDGE RESEARCH" FIVE YEARS AGO?  MORE CURIOUS IS THAT OF THE ESTIMATED $2.1 BILLION TOTAL PUBLIC SUPPORT AND REVENUE RAISED (1982-2010) SGK SPENT ONLY $500 MILLION ON RESEARCH.

Pink also pays for awareness, because despite the assumption that everyone knows all there is to know about breast cancer, women still tell me they don't need a mammogram because there's no history of breast cancer in their family (awareness check: most people diagnosed with breast cancer have no family history); or because they've never worn underwire bras (awareness check: underwire bras have nothing to do with breast cancer).

"FINDING CANCER DOES NOT ALWAYS SAVE LIVES....MAMMOGRAMS CAN RESULT IN FALSE-NEGATIVE RESULTS [AS MY PERSONAL HISTORY OF MAMMOGRAMS ATTEST]. REGRETTABLY, SCREENING MAMMOGRAMS MISS UP TO 20% OF BREAST CANCERS THAT ARE PRESENT AT THE TIME OF SCREENING. FURTHER... SCREENING MAMMOGRAMS ALSO FIND CANCERS & CASES OF DCIS THAT WILL NEVER CAUSE SYMPTOMS OR THREATEN A WOMAN'S LIFE, LEADING TO 'OVERDIAGNOSIS' [AND 'OVERTREATMENT'] OF BREAST CANCER...EXPOSING WOMEN UNNECESSARILY TO THE ADVERSE EFFECTS ASSOCIATED WITH CANCER THERAPY."

http://www.cancer.gov/cancertopics/factsheet/detection/mammograms 

So no, there's not too much awareness. And yes, all this pink does quite a bit of good.

The $685 million that Komen has invested in research over 30 years has helped reduce breast cancer death rates by 31 percent since 1991. It has helped improve five-year relative survival rates for early stage cancers to 99 percent, up from 74 percent when I started. It has paid for treatments that are making it possible for many women, even with aggressive or metastatic disease, to live longer, and it has provided key research findings for patients with other types of cancer, most notably those with BRCA 1 or BRCA 2 genetic mutations.

SGK's OWN 990 REPORTS INDICATE ONLY $500 MILLION INVESTED, NOT $685M.  I CULLED AGAIN THROUGH KOMEN'S REPORTS, AFTER READING MS. BRINKER'S OP-ED, AND COULD NOT FIND THE ADDITIONAL $185 MILLION SHE PADS ON TO THE ABOVE FIGURE. MORE IMPORTANTLY, HOWEVER, IN 1991, 43,583 WOMEN DIED FROM BREAST CANCER.  http://www.cdc.gov/mmwr/preview/mmwrhtml/00026281.html 
ACCORDING TO THE CDC, IN 2007 (the most recent year numbers that are currently available) 40,598 WOMEN DIED IN THE U.S. FROM BREAST CANCER. http://www.cdc.gov/cancer/breast/statistics/index.html THE DIFFERENCE IS 14.6 %, NOT 31%; AND SGK'S ACTUAL CONTRIBUTION TO THE ACTUAL DECREASE IN NUMBERS IS NOT DEFINITIVE. ANECDOTALLY, OF THE 3 ONCOLOGISTS I INTERVIEWED FOR  MY OWN CARE, ALL OF THEM CONCURRED THAT THERE REALLY HAS NOT BEEN A DECREASE IN THE DEATH RATE FROM BREAST CANCER IN 50 YEARS. THE REPORTED DIFFERENCES IS HOW THE DEATHS OF WOMEN ARE BEING CATEGORIZED. E.G. UTERINE CANCER, OVARIAN CANCER vs. MBC.

At Komen alone, the funds raised from pink paid for 700,000 breast screenings last year for poor and uninsured women, and provided financial and social support for another 100,000.

BY THE WAY, SGK OWNS STOCK IN GENERAL ELECTRIC - ONE OF THE LARGEST MAKERS OF MAMMOGRAPHY EQUIPMENT IN THE WORLD.

All told, Susan G. Komen has pumped $1.3 billion into programs in thousands of communities that provide this real help to real women, men and families facing breast cancer.

In California, Komen has funded $64 million since 1982 to research at institutions across the state, including 68 active research projects totaling $30 million today. The eight Komen Affiliates serving California have awarded millions to local community programs and fought to preserve state-funded breast cancer programs for California's low-income and underserved women.

The research we're funding here, and globally, is investigating environmental factors in breast cancer, real prevention strategies, ways to find breast cancer before symptoms appear, ways to stop it before it spreads, and ways to effectively treat the deadliest forms of this disease for those with metastatic and aggressive disease. The community programs target women who, without our help, will not get access to screenings, cancer treatment and follow-up care.

GLAD YOU BROUGHT UP ENVIRONMENTAL FACTORS MS. BRINKER...WHAT ABOUT SGK'S REQUISITION OF ITS NEW PERFUME, "PROMISE ME," THAT CONTAINS GALAXOLIDE - A KNOWN HORMONE DISRUPTER, AND TOLUENE - A POTENT NEUROTOXICANT BANNED BY THE INTERNATIONAL FRAGRANCE ASSOCIATION. http://boo-bee-trap.blogspot.com/2011/09/promise-me-pink.html
WHAT ABOUT SGK'S FLIP-FLOPPING ON THE IMPACT OF POLYCARBONATE PLASTICS CONTAINING BPAs ON OUR HEALTH. SEE, SGK WEBSITE 02/2011. COULD SGK'S INCONSISTENT STANCE ON BPA LADEN PLASTICS BE ATTRIBUTABLE TO ITS BRAND NAMED SPONSORS: COCA-COLA, GENERAL MILLS, GEORGIA-PACIFIC, 3M - INDUSTRIES THAT ALL USE BPAs IN THEIR MANUFACTURING AND PACKAGING.  MS. BRINKER, I NOTE THAT YOU ARE ALSO SILENT AS TO THE FACT THAT SGK OWNS STOCK IN SEVERAL PHARMACEUTICAL COMPANIES, INCLUDING ASTRA-ZENECA (aka AZKONOBEL), THE MAKER OF TAMOXIFEN - WHOSE SIDE EFFECTS INCLUDE UTERINE CANCER.

Research and community programs cost money, and we make no apologies for raising the funds that make them possible. In fact, we need to raise more, because - despite our advances - a woman is still being diagnosed with breast cancer every 19 seconds and a woman dies of breast cancer every 74 seconds somewhere in the world.

WHILE WOMEN CONTINUE TO DIE AT RATES THAT HAVE NOT SIGNIFICANTLY CHANGED SINCE 1960, SGK SPENDS NEARLY $1 MILLION YEARLY SUING SMALL CHARITIES FOR THE USE OF THE WORD: "CURE." SGK'S GENERAL COUNSEL, JONATHAN BLUM, WHEN COMMENTING ON A LEGAL BATTLE INVOLVING SGK AND A SMALL LUNG CANCER NON-PROFIT, FOR USING THE WORD "CURE", STATED: "WE SEE IT AS RESPONSIBLE STEWARDSHIP OF OUR DONOR'S FUNDS.

Do consumers need to be aware of where their dollars are going? Absolutely. We urge people to do their homework before donating to ensure that their dollars go to organizations that are legitimately engaged in ending breast cancer.

WHICH IS WHY IN REVIEWING SGK'S 990s YOU CAN DISCOVER THAT THE CLAIMS BY MS. BRINKER, ON BEHALF OF SGK, DO NOT PAN OUT.

If you do like pink - and our surveys say most people do - then I thank you for seeing it for what it is: the symbol of a movement that is doing all that it can to end suffering from the leading cancer killer of women worldwide. Half a million women will die of breast cancer in the world this year, including 40,000 right here in the United States.

AGAIN, MS. BRINKER, IT CANNOT BE OVERSTATED, THAT THIS NUMBER HAS NOT SUBSTANTIVELY CHANGED IN 50 YEARS, DESPITE THE BILLIONS RAISED...AND SPENT BY SGK.

Roulette Wheels as breast markers
...nice. At least they're organic [?]

There won't be enough pink until the fight against this disease is won.

© Copyright The Sacramento Bee. All rights reserved.

Showing 8 comments (these are the total comments that were posted)

• 
  Bobbalino                                           

  You say that your research over the last 30 years "has helped reduce breast cancer death rates by 31 percent since 1991. " But breast cancer mortality is going up not down!

  

• Carrie Anne Kelly                                           

  Lets stop "cutesifying" Breast Cancer with all the pink nonsense and get to the matter at hand which is that your organization is aligning itself with the very industries that are suspect to be using harmful material in the production of their products. If you are really interested in finding the cure, then show us by demanding accountability from the food, cosmetic and household cleaning industry. Oh right. You're too busy suing smaller organizations for using the term "For the Cure".

  
  
• 
  BBZinger                                           

  Ms. Brinker has been defending pink for years. Her anecdotes don't prove her point. If women with breast cancer are living in their cars, they don't need pink, they need money. When I was Executive Director of Breast Cancer Action, and since, I have heard numerous complaints about Komen's non-responsiveness to individuals in need of help, despite the enormous resources at Komen's disposal. Pink is a pretty color, but there is nothing pretty or happy about a breast cancer diagnosis. For a different view, see www.barbarabrenner.net
• 
  natrum                                           

  Ms Brinker, What I do not understand, is why so very little, if any, of the Komen Millions of dollars is spent on education regarding prevention. There is good information out there, and much benefit could come from people learning about diet, the protection afforded by adequate vitamin D, the fact that ingested sugar directly feeds cancer cells, the toxins in our consumer products, the dangers of radiation.... the list is very long. Heredity is a small part of risk. And even then, gene expression is not an absolute. The environment plays a key role. Pink buckets filled with chicken pumped with hormones and antibiotics, coated in who-knows-what, fried in genetically modified soy oil, is an example of the environmental dangers to avoid.
  Breast cancer "awareness" needs to include actions to take to avoid it, even at the risk of offending industrial sponsors whose products are implicated in causation.  This is information I want my sister to know.
• 
  Erika Munson Sudz                                           

  Funny thing, I looked ALL Over the Komen web site for assistance regarding prescriptions/travel/insurance/lodging. All I found were links to OTHER organizations to ask for assistance there was nothing there showing how Komen was offering to help anyone. Such a scam

  
• ricaLIVESTRONG                                           

  The Pink Machine driven by Komen is a FARCE. I have called and tried to contact Komen for support during my breast cancer battle. Those requests for help, the chance to redeem themselves in my eyes, were ignored, though I WAS subscribed, unwillingly, to their marketing material. Thanks, Komen, but LIVESTRONG will get every cancer-fighting dime I have to give.
  
  The ongoing hypocrisy of Komen is sickening, to the point that I need to ingest some pink - Pepto-Bismol.
  
  Partnering with companies like KFC for a pink bucket, which only ENCOURAGES behavior that can INCREASE CHANCES of breast cancer, selling perfume and glamorizing the fight by wrapping it up in pink bows, and showing beautifully made-up bald women (who are obviously wearing bald caps) is false advertising and INSULTING to those of us in the throes of the fight.
  
  And do I even need to bring up the despicable habit of taking over the phrase "For The Cure?" Well, here. Sue me.
  
  I encourage EVERYONE out there to REBEL For The Cure.
  Pink ribbons are not welcome in my home, or hospital room. Yellow is.
  
  LIVE STRONG.     
• 
  CA_Comment                                          

  Ms. Brinker - respectfully the public does support the need to help connect and drive critical funds to research that will deliver a cure, improve awareness, improve early detection, aid diagnosis, and help women and men get access to critical care for this cancer so they may fight and survive this disease, as well as regain quality and quantity of life. To say we do not care about this because we question the current implementation of the pink campaign is incorrect.
  
  We are giving you valuable feedback that the pink campaign is important (otherwise no one would care to give you feedback), We are telling you it appears the pink campaign is at risk of becoming distracted/diluted and in some business alliances and implementations the campaign is downright hijacked. You may not like this message...but this message is real and affords an opportunity for you and others working to make a difference to consider and adjust. We are not telling you to stop. We are however telling you there is a need to make some changes or you risk alienating even more of your supporters.
  
  Although your organization holds a position as a leading voice on this cause...you must remember this is a human issue we all own. We are your stakeholders. We want and need you (and other organizations who can help us make a real impact) to be successful. In exchange for our support, we are demanding a vigilance by you or anyone else that takes this role. Our message is be attentive that the means-to-an-end approach does not become the actual downfall for the support needed to defeat the cancer itself. What decisions you make...good or bad...not only reverberate to breast cancers...but they spill over to work being done for all cancers.
  
• Miss Susie                                         

  I have to agree with this idea. When I saw the pink KFC basket, I thought, really? Fast food containers for cancer--doesn't that just encourage people to live a lifestyle that promotes disease while allowing themselves to feel good about it because it's going to cancer? I felt the same way when another chain (or maybe it was also KFC) was promoting a beverage special--read: cola--to help the fight against diabetes.
  
  When it's all about buying 'pink,' you run the risk of marginalizing the issue--it's not a serious medical issue, we can just solve it by shopping. The various partnerships make it also seem a little hokey. I never buy pink because I always stop and think to myself, well, once the money spent goes to pay for the actual item, the costs of shipping and production, marketing, packaging, et cetera, there's probably very little left for actual breast cancer. (The few things I need that come in pink don't really match my house, like the KitchenAid mixer I saw when I was buying one.)
  
  I'm all in favor of getting more pink out there for the awareness, but I think there is a valid point to be made about being cautious of various commercial partnerships.

  
  

A Constant State of Being

******

SURREAL is a constant state of being when you live with a chronic disease.

You are in a surreal state of numbness, waiting for the next test / imaging results. Trying to convince yourself you are not worried. Holding your breath while you pretend to breathe.

It is sensorally surreal, the incessant barrage of cancer commercials & tag lines: "changing the face of cancer" "changing the history of cancer" "cancer has a new enemy."

It is incomprehensibly surreal watching pink walkers chanting "Fight, fight, fight" when all I really I want to do is LIVE...LIVE...LIVE.

It is ragingly surreal wondering daily, what does this pain mean; what does that ache indicate.

You are in a protective surreal bubble, convincing yourself that you actually do not mind the bruised veins. That in some grotesque way they are a badge of honor.

It is glaringly surreal being so acutely aware of those moments when you actually feel good, because those moments seem to arrive less often.

It is the epitome of surreal, being awoken each morning by a pain, by an ache, and making the conscious decision that regardless, "it is time to make the donuts," and you are the one that has to do the making.

The "Cancer" Conversation

******

The "cancer conversation" can be a focal point of stress for me, personally. It is not that I don't or won't converse. When specific, non-judgmental inquiry is initiated I do not have any qualms about answering. The open-ended "how are you feeling"? Or the blatant, expectation for me to "dish" - I can feel my emotional protective wall envelope me. Not because I am protecting myself from the inquiring person, but because I am protecting myself, from myself.  More so when family "expects" me to be the one to initiate the discussion. I also, selfishly, (and I do use that description quite a bit when trying to express how I am dealing with my chronic illness. Not because I am being self-deprecating, but because cancer is a "selfish" state of being) squirm at the thought of having to deal with the inquiring persons reactions.

Then there is the discomfort of the unknown. When presented with the open-ended query of: "how are you feeling [or doing]"; I am not sure just how much the inquisitor really wants to know. We live in a society where the perfunctory start to every conversation, whether it be with the SB Barrista, a client, an adversary, or a BFF, starts with "how are you"

In short, its complicated

The below synopsis, of a study conducted by The University of Texas' study on cancer communication, delves into the complexity of this "conversation."

Reprinted from "Navigating Cancer" - October 12, 2011

Some people choose to discuss their health concerns with those who are closest to them. Others prefer professional counselors, support group members, other survivors, or acquaintances made through the Internet. Not everyone finds the connection they need from the same source, and the depth of the conversation will vary as well.

Communication about an illness was the focus of a study conducted at The University of Texas which provided interesting results. Researchers specifically looked at patients asserting control over how they chose to discuss their illness, or chose not to discuss it. The overall findings suggest when patients assert control over communication it helps to overcome feelings of helplessness. In this way patients can determine an aspect of how they want to face the challenges of their diagnosis.
Erin Donovan-Kicken, assistant professor of communication, led the research to examine the strategies people with cancer use to communicate with family, friends, and colleagues. Donovan-Kicken and her team interviewed cancer survivors on how they approached the topic of their diagnosis with various audiences. The team gathered data regarding the advice patients received, the challenges they faced, and the recommendations they would make when talking about a disease. The participants were also asked to evaluate existing patient literature and how they managed information about their illness.

The study results indicate that asserting control over communication is an important factor for patients coping with the stress of cancer. Yet despite best efforts to control that communication, patients can’t control other people’s reaction. Patients will benefit from setting boundaries with family and friends when they need space to be ill or feel emotional in private. They should be allowed to focus on themselves without needing to support others, and to avoid people who are overly solicitous. Choosing not to engage in social discussions about an illness can prove to be an empowering decision for some patients.


Ultimately Donovan-Kicken’s research defined the difference between asking –
“Are you opening up to people?” and
“Do you have people you can talk to if you want to open up?”

The distinction is note-worthy for oncologists and survivor advocacy groups who counsel and provide support to patients. Patient literature could also be refined to emphasize what is meaningful about communication from patients’ perspectives. It could include suggestions on how to manage or withhold from personal health discussions, and establish boundaries allowing patients to experience their illness in a way that best suits them.

Understanding Lymphatic Metastases ... A Beginner's Primer

******

Spread of Cancer through the Lymphatic System

(Summer 2011 - Reprinted from Cancer Quest / Emory University / Winship Cancer Institute  http://www.cancerquest.org )

The Lymphatic System


The lymphatic system plays an important role in controlling the movement of fluid throughout the body. Specifically the lymphatic system controls the flow of lymph, a colorless fluid containing oxygen, proteins, sugar (glucose) and lymphocytes (cyte=cell). Once they are formed in the bone marrow, lymphocytes circulate in the body and reside in lymphatic tissue including lymph nodes and the spleen, where they search for and await contact with their target proteins. The lymphatic system is a system of vessels (tubes) that is present all throughout the body. Like the more familiar circulatory system, the lymphatic system carries fluid, proteins and cells of the immune system.

Red blood cells are not found in the lymphatic system. The two systems (lymphatic and circulatory) are connected. The lymphatic system picks up fluid and cells from around the body and returns them to the circulatory system via ducts located in the neck/shoulder area. The fluid within the vessels is known as lymph. There are some similarities and differences between the (more well known) circulatory system and the lymphatic system.

Small lymphatic vessels merge into larger ones and these large vessels eventually empty into lymph nodes. Lymph nodes are kidney bean shaped tissues that are found in grape-like clusters in several locations around the body. Lymph nodes are sites of immune system activation and immune cell proliferation (growth). The fluid in this extensive network flows throughout the body, much like the blood supply. It is the movement of cancer cells into the lymphatic system, specifically the lymph nodes, that is used in the detection of metastatic disease.

Spread of Cancer Through the Lymphatic System

The lymphatic system is of great importance in cancer for several reasons:

• Cancer cells can spread (metastasize) by getting into the lymphatic system.
• Many cancer types are classified or staged by whether or not cancer cells can be found in lymph nodes close to the site of the original tumor. The logic is this: The lymphatic system is found all over the body so if cancer cells from a tumor have made it that far, they may also have traveled to distant locations.

When a cancer cell has moved through the blood or lymphatic systems or via direct contact to another location, it may divide and form a tumor at the new site. Metastatic tumors often interfere with the functions of the organs involved and lead to the morbidity and mortality seen in cancer.
The lymphatic system plays a crucial role in the metastasis of certain cancers. Lymphatic vessels are designed for entry and exit of immune cells, and are therefore easy for tumor cells to enter. In addition, the flow of lymph is quite slow, so there is little stress to harm cells.⁽¹⁾ Researchers originally believed tumor cells invaded the lymphatic system by eroding the vessel walls as the tumor advanced and metastasis would then occur by passive drainage. However, current evidence suggests the interactions between metastasizing cells and lymph vessels are much more active and complex, and specific interactions between the two are required.

The presence of metastases in lymph nodes near the primary tumor often indicates metastasis to distant organs, and is a significant prognostic indicator in many cancers. To assess the presence of metastasis to surrounding lymph nodes, physicians perform a lymph node biopsy. In this procedure, the lymph nodes are removed by surgery and are checked for the presence of cancer cells. Nodes are determined either positive or negative for cancer.

Because lymph drainage pathways from a tumor vary greatly between patients, even for the same area, up to 30% of tumors cannot be accurately predicted to migrate to specific lymph nodes. Improvement in lymphatic imaging and mapping are needed to ensure that metastasizing cancers are not accidentally missed. ⁽²⁾


The diagram below shows the lymphatic system


  

1. Kopfstein, L., and G. Christofori. 2006. Metastasis: cell-autonomous mechanisms versus contributions by the tumor microenvironment. Cell Mol Life Sci. 63:449-68. [PUBMED]
2. Shayan, R., M.G. Achen, and S.A. Stacker. 2006. Lymphatic vessels in cancer metastasis: bridging the gaps. Carcinogenesis. 27:1729-38. [PUBMED]

Routes of Metastasis

There are three primary ways tumors can spread to distant organs:

1. Through the circulatory (blood) system (hematogenous)
2. Through the lymphatic system
3. Through the body wall into the abdominal and chest cavities (transcoelomic).

The circulatory system is the primary route of spread to distant organs, while lymphatic vessels provide a route to local lymph nodes, after which metastases often travel through the blood ⁽¹⁾ While the circulatory system appears to be the most common route, the extent of lymphatic versus hematogenous spread appears to depend on the origin and location of the primary tumor.⁽²⁾ For example, bone and soft tissue tumors (sarcomas) spread primarily through the blood, while melanoma, breast, lung and gastrointestinal tumors spread through the lymphatic system.⁽³⁾ Transcoelomic spread is fairly uncommon, and appears to be restricted to mesotheliomas and ovarian carcinomas.⁽⁴⁾

In order for tumor cells to gain access to lymphatic or blood vessels, tumors need to promote the growth of these vessels into and around the tumor. Growth of blood vessels is called angiogenesis, and growth of lymphatic vessels is lymphangiogenesis.

1. Bacac, M., and I. Stamenkovic. 2008. Metastatic cancer cell. Annu Rev Pathol. 3:221-47. [PUBMED]
2. Gerhardt, H., and H. Semb. 2008. Pericytes: gatekeepers in tumour cell metastasis? J Mol Med. 86:135-44. [PUBMED]
3. Kopfstein, L., and G. Christofori. 2006. Metastasis: cell-autonomous mechanisms versus contributions by the tumor microenvironment. Cell Mol Life Sci. 63:449-68. [PUBMED]
4. Tan DS, Agarwal R, Kaye SB. Mechanisms of transcoelomic metastasis in ovarian cancer. Lancet Oncol. 2006 Nov;7(11):925-34. [PUBMED]

Treatments that Target Metastasis

Metastatic Suppressors

Recent work has uncovered a group of molecules that act to induce or suppress metastasis without affecting the growth of the primary tumor. Many molecules, termed Metastatic Suppressors, have been identified. These molecules are critical for different stages of metastasis, and may function to inhibit cell death upon loss of cell adhesion, or enhance the ability of cells to migrate through the stroma. Researchers are hopeful that these molecules may prove valuable as anti-cancer/anti-metastasis targets.⁽¹⁾
It is important to realize that the majority of current anti-cancer drug studies are conducted using primary or cultured tumor cells, and the efficacy of each drug is measured by its ability to reduce the size of primary tumors or kill cells being grown in laboratories. However, because metastatic suppressors do not affect growth of the primary tumor, it is likely like many potentially useful anti-metastatic drugs have been overlooked. New methods of analyzing the ability of drugs to inhibit metastasis, rather than primary tumor growth, are being developed, and should lead to a useful new class of therapeutic compounds.⁽²⁾

Anti-angiogenesis Therapy

Because metastasis relies on the growth of new blood vessels in both the primary and secondary tumors, drugs that inhibit angiogenesis may inhibit metastasis. Currently, the combination of anti-angiogenesis drugs with chemotherapy/radiation is the most effect treatment. Unfortunately, many tumors become resistant to the anti-angiogenesis treatment, so this is generally not a longterm solution. ⁽³⁾

Current research into inhibiting metastasis is focusing on understanding which step of metastasis is the most amenable to therapy. The identification of metastatic suppressor genes has opened up many exciting new potential targets for preventing and inhibiting this deadly event.

1. Stafford, L.J., K.S. Vaidya, and D.R. Welch. 2008. Metastasis suppressors genes in cancer. Int J Biochem Cell Biol. 40:874-91. [PUBMED]
2. Steeg, P.S. 2006. Tumor metastasis: mechanistic insights and clinical challenges. Nat Med. 12:895-904. [PUBMED]
3. Gupta, G.P., and J. Massague. 2006. Cancer metastasis: building a framework. Cell. 127:679-95. [PUBMED]