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If you're seeking a straightforward answer, here it is: Teflon and most non-stick cookware are generally regarded as safe for kitchen use under normal cooking conditions. However, the reality is more nuanced. While Teflon itself is stable and non-reactive at standard cooking temperatures, concerns arise from the chemicals involved in its production, which may pose health and environmental risks. To understand these concerns better, let’s clarify a few key terms. Teflon, technically known as polytetrafluoroethylene (PTFE), is a synthetic resin popular in a wide range of industrial applications, including non-stick cookware, due to its slick, non-reactive surface. Developed and patented by the American company DuPont in the 1940s, PTFE quickly became a household staple for its convenience in cooking. In producing Teflon, manufacturers often use chemicals known as PFAS (per- and polyfluoroalkyl substances). PFAS is a broad category of human-made chemicals valued for their resistance to heat, water, and oil. This group includes older substances such as PFOA (perfluorooctanoic acid) and PFOS (perfluorooctane sulfonate), as well as newer alternatives like GenX.  Is Teflon Safe? What Science Tells Us For years, scientists have been studying Teflon to find out if it’s safe for us to use. Testing this directly on humans would be unethical, so researchers have to rely on animal studies or look at people who are already exposed, like workers in Teflon factories. One well-known study exposed rats to super-heated Teflon (about 900°F or 486°C) for 15 minutes. The fumes released were toxic to the rats. But this finding isn't new, the toxicity of these fumes are well known. Cases of what has been called “Teflon flu” have been popping up in the news. It is well-accepted that overheating a non-stick pan can release fumes, which may cause flu-like symptoms that typically resolve within a day or two. Should I stop using Teflon pans then? No. One common factor in these studies and cases is that the pans were heated to extreme temperatures, far beyond what most people typically use in the kitchen and well above the manufacturer’s recommendations. Non-stick pans are safe as long as you follow the manufacturers recommendations and keep temperatures below 500°F (260°C). No health concerns have been found when non-stick pans are used as directed. Another method used to evaluate safety is studying whether any harmful chemicals migrate from the non-stick coating into food. A study by the Central Science Laboratory in York, UK, tested 26 non-stick cookware samples by heating them to 250°C for 30 minutes, simulating typical kitchen conditions. Their findings? “None of the substances identified had the potential to exceed their tolerable daily intake (TDI) value”. In summary, based on available research, including several studies, there is no evidence that Teflon escapes from cookware in substantial amounts and poses any health risk.  When it comes to Teflon potentially leaching into your food, following the manufacturer’s recommendations is key. Non-stick cookware doesn’t last forever; once you notice scratches or peeling on the coating, it’s time to replace it. To help extend the life of your non-stick pan, use wooden, silicone, or plastic utensils and wash it gently by hand. The Real Concern: Manufacturing Chemicals The real concerns stem from the production process of Teflon and the chemicals involved, such as PFOA (perfluorooctanoic acid). PFOA is known to disrupt hormones and has been classified by the International Agency for Research on Cancer (IARC) as possibly carcinogenic to humans. It is highly persistent in the environment, and as of 2011, PFOA was found in the blood of nearly 95% of Americans. With a half-life of several years in the body, PFOA raises concerns about long-term health effects, including potential links to cancer. Workers at manufacturing sites for these chemicals have been found to have a higher risk of developing certain types of cancer. Studies examining cancer rates in individuals living near or working in PFOA-related chemical plants have suggested an increased risk of testicular and kidney cancers with higher PFOA exposure. The contamination of water sources by these chemicals remains a significant and unresolved issue. Due to these concerns, PFOA has largely been replaced by other chemicals, such as GenX. You might wonder, 'So, is the problem solved?' Not exactly. The chemicals replacing PFOA still belong to the same category, PFAS. GenX is one of these alternatives, and while it's less likely to accumulate in the body, concerns remain. Some studies suggest that these newer chemicals may pose similar health risks as their predecessors. Conclusion In conclusion, if you’re wondering whether non-stick cookware is safe to use for your Thanksgiving cooking, the short answer is yes—it’s safe to use under normal cooking conditions. There has never been any evidence that Teflon, when used under normal cooking conditions, poses a health risk. As long as you follow the manufacturer’s guidelines—keeping temperatures below 500°F (260°C) and replacing pans if the coating shows signs of damage—non-stick pans are safe to use. However, the story doesn’t end there. The main risk associated with Teflon isn’t from using it in your kitchen; it’s an environmental and production-related issue tied to the chemicals used to make it, like PFOA. These chemicals have been shown to contaminate water sources and persist in the environment for years, raising long-term health concerns, especially for communities near manufacturing sites. While Teflon itself is safe for cooking when used correctly, the impact of these manufacturing chemicals on the environment and human health remains a serious concern.  Written by Luis Guilherme

A call that changed Christmas It was Christmas Eve in 2018, and as I was on the way home from my last-minute Christmas shopping, I received a call from my pulmonologist.  While I knew she would call me any day now, just as soon as she received back my lung biopsy results, I pulled my car over, took the biggest breath and accepted the call. After so many doctor visits and doubts that lung cancer would be the finding (given my age and smoking history), it was official, my lung biopsy indicated that I had lung cancer . I didn’t understand the importance of it at that moment, but my doctor also shared the “good news” that there was biomarker testing conducted, and it revealed that I have an EGFR mutation.  We ended the call with a plan to come in and meet with a thoracic surgeon, something she arranged that same day. We ended the call, a I found myself parked in a spot where I have no doubt I was meant to be, at the church that is just down the road from my house. I remember feeling numb, frozen with so many emotions but then I looked over at the church and shifted to prayer. I prayed for strength and peace, especially for my children. Thankful that I had this private moment to receive the news and gather strength for what was to become my new life. Starting cancer treatment Just after Christmas, a few days into the New Year, I had my surgery which included a br onchoscopy, mediastinoscopy, right lower lobectomy, thoracic lymphadenectomy. The biopsy from this surgery indicated I had Stage IIB Adenocarcinoma.  After recovering from the surgery, I completed 4 cycles of adjuvant chemotherapy by May 2019. Due to having chronic pain and many other issues, I had a PET scan  on 2/3/23, which showed that I had bleeding lesion in my brain, spine, scapula, sacrum, and other lymph node avidity.   First course of treatment was having a craniotomy followed by SRS radiation.  Following the surgery and radiation in April 2023, I started taking Tagrisso which is a targeted therapy to treat lung cancer with specific mutations. I have had a positive response, with my recent scans showing “Stable to slight improvement with NO recurrent disease”.  Learning I had cancer was what I have come to see as a gift Looking back on what felt like was a very hopeless day on Christmas Eve in 2018, I can honestly say that learning I had cancer was what I have come to see as a gift . While there have been many difficult moments, when things seemed dire, HOPE has kept me going and with gratitude for the gift of life and the countless blessings. There’s a phrase I say (and live) daily, “progress over perfection”. These three words strengthen me and remind me to focus on what I can do NOT what I can’t. No day is promised, and I wake each day with so much gratitude and hope! Lung cancer resources Lung Cancer Initiative (LCI) and LiveLung have been two of the organizations offering wonderful support and hope. In addition to their boundless support through survivor engagement, fundraisers, research and advocacy, LCI connected me with Wind River for the Lung Cancer Retreat, the beginning of what has come to be the most meaningful friendships and connections.  The gift of support Sometimes we just need someone to be there, not to fix anything or do anything in particular, but just to let us know we are supported and cared about.  The gift of having this support helped me learn to live post diagnosis, during and after treatment and in between each surveillance scan .  My words of hope I’d like to share with all survivors and caregivers, is to REMEMBER TO LIVE WHILE YOU’RE BUSY SURVIVING!

I don't write enough about mental health so here goes. IT'S VERY IMPORTANT!!!!! This post is going to cover two things. First, my search for a therapist . And second, the state of my mental health and how it impacts me. My search for a therapist Ok, on to the first. Everyone knows the story of Goldilocks, right? This bed is too hard, this bed is too soft, this bed is juuuuuuuust right! Well, that's been my therapy journey (I am not a fan of the word "journey" (overused) but it works here). My first therapist in Portland was very helpful. He helped me get a lot of insights and connected a lot of dots for me. He also gave me perspective when I needed it. Example: Not to be morbid, but when the cancer thing started we discussed death. As I was talking about it, his response was "We are all going to die and no one knows when". That kind of snapped me back to reality. He also helped me realize that I am not afraid of dying, but I am afraid of not living. Two very different ideas. BUT, he never spoke (or very little). Like literally. I would walk in and he wouldn't say anything. For those who know me, I am very chatty. It was almost always awkward and the awkwardness got me to talk more and to process. I would not look forward to it and found myself worried about what I would discuss in every session. He was too hard. My next therapist was the exact opposite. Very nice, empathetic, chatty, and easy to talk to. BUT, she didn't challenge me at all. She wouldn't use things that I had said in the past to connect ideas, wouldn't call me out on bullshit, etc. We discussed it (I am very honest) but we still couldn't get there. She was too soft. So now, I am looking for juuuuuuuuuust right. I think I found her. I will let you know soon. She seems to have good energy, seems very honest, and seems like she will listen to me and push me. After all, if you leave a therapy session and feel like it was easy, it's worth questioning the value of the session. One thing I like is that when we spoke (I now interview therapists to see if it feels like a fit before I commit) I asked her if she wanted to see my blog or anything else. She said no, she wants to know how I am in the moment and to discuss that. I liked that approach. So fingers crossed! And, she's a NYer. And I seem to gravitate to that energy. It's the right amount of humor, directness, no BS, and insight. My mental health state Now let's discuss my state. A few weeks ago, I was mopey. I don't know how Krista did it but I couldn't have been fun to be around. I wasn't mean, depressed or anything, I just didn't have my usual energy. I started to realize it last week. Once I realized it I decided to do something about it (this wasn't one of those, "it's okay to be down" feelings, it was more "I am bored and need to do something different"). So I went to the gym , I hiked twice (5 miles on a beautiful trail and 6.3 miles in Forest Park (look it up, it's amazing), went to the beach and I went skydiving. Guess what? I feel much better. I am back to pushing myself and doing different things. I am happier, more engaged, and feel better. Now I am working on the house and planning trips. There isn't one neat bow to tie around this post other than just to say that my mental health is what drives me. I focus and spend more time on my mental health, than I do on treatments. And it works. When I am feeling good mentally, I feel good physically. My guess is that 60-70% of my time is focused on my mental health through activities, music, writing, walking, therapy, etc. There are 10,080 minutes in a week and 40,320 minutes in 4 weeks. My physical treatment is a shot that takes 30 minutes once every 28 days (4 weeks), which leaves a lot of time to focus on my mental state. I am beginning to let that sink in.

Chemotherapy was born from the ashes of war. The first drug used as a chemotherapy agent came from an unexpected source: mustard gas, a highly toxic substance and one of the most effective weapons ever developed. The gas that was first used during World War I and has a long history as a chemical weapon also served as the molecular basis for the first chemotherapy agent, known as Mechlorethamine. A history that is a subtle invitation to understand the nature of cancer treatment from its burdens, very well represented by Mechlorethamine, to its success. From its beginnings to the present day, cancer treatment has been marked by numerous side effects, but that is a reality that is slowly changing. To raise awareness for Lung Cancer Awareness Month , let’s briefly tell the history of how lung cancer treatment is becoming a showcase of 21st-century discoveries. Mechlorethamine and the nature of chemotherapy Great things can arise from tragedy. In an effort to understand how mustard gas affected the human body, autopsies were performed on 75 soldiers exposed to it. These autopsies revealed a significant reduction in white blood cells in the soldiers. Apparently, when inhaled, the gas was especially toxic to white blood cells. This led to the hypothesis that a similar substance might be used to target cancerous white blood cells in lymphoma patients. Goodman and Gilman, two of the greatest pharmacists of all time, in their lab at Yale, designed a chemically altered version of mustard gas. When tested on a terminally ill lymphosarcoma patient, the drug yielded fantastic results, destroying cancer cells like never seen before. Mechlorethamine is still in use today under the interesting name "Mustargen".  Mechlorethamine became the first chemotherapy agent, marking the beginning of decades of investment and discovery in cancer treatment. However, like the many chemotherapy drugs that followed, it comes with significant side effects, and there is a reason for this.  Pharmacology is about specificity, which means targeting specific disease mechanisms while minimizing effects on other systems in the body. This approach works well for bacteria, for example, as their cellular structures differ from ours, allowing for targeted drugs. But cancer presents a unique challenge, as cancer cells are, at their core, human cells. How, then, can we target cancer cells without harming healthy cells? Truthfully, throughout most of cancer treatment history, we couldn’t. Most chemotherapy drugs target molecules involved in cell reproduction, which, although also present in normal human cells, are more active in cancer cells. That is the reason why chemotherapy has so many adverse effects.  But there is a promising future ahead This was the reality until things began to evolve near the 21st century. Cancer treatment has transformed in extraordinary ways. As we studied cancer in greater detail, we discovered genetic alterations, proteins, and receptors that are unique or more active in cancer cells. This understanding allowed us to develop drugs targeting these specific traits. We call this "targeted therapy," a broad and somewhat loosely defined category of drugs that aim for these unique cancer-specific characteristics. With targeted therapy, we can focus on attacking cancer cells directly, sparing more of the healthy cells. One of the most exciting examples of targeted therapy’s impact is seen in treatments for Non-Small Cell Lung Cancer (NSCLC), which accounts for 85% of lung cancer cases. Several key mutations have been identified in NSCLC, and therapies designed to target these mutations have shown remarkable clinical success. Genes like EGFR, MET, ALK, RET, and HER2 frequently exhibit mutations in lung cancer, and specific drugs have been developed to target these abnormalities. For instance, a patient with an EGFR mutation (found in about 15% of cases in the U.S.) can receive a treatment designed to target that specific mutation. As cancer cells evolve to resist EGFR inhibitors, science has kept pace by developing second and third-generation drugs to outsmart this resistance. Immunotherapy has also emerged as a first-line treatment for certain types of lung cancer. Immune checkpoint inhibitors are a novel category of Immunotherapy drugs that enable the body’s immune system to attack lung cancer. Normally, cancer cells evade immune response by sending "don’t attack" signals to immune cells. Immunotherapy drugs block these signals, allowing the immune system to recognize and target the cancer. It’s like lifting a disguise, enabling the body to fight back with its own defenses. For some lung cancer patients who have the specific receptor that these drugs aim for, this approach can lead to lasting remission. This highly specific treatment means that some patients may completely avoid common chemotherapy-related side effects, such as hair loss. Since the prevalence of these mutations varies among patients, genetic testing has become essential in identifying them. This is why modern lung cancer treatment includes a comprehensive set of genetic tests, enabling doctors to tailor therapies to each cancer’s unique genetic profile. The vision of personalized therapy is no longer just a dream, it’s becoming a reality. Over the past decades, these advancements have led to changes in what truly matters: significant improvements in overall survival and reductions in mortality. The two-year survival rate among men with NSCLC improved substantially, from 26% for those diagnosed in 2001 to 35% for those diagnosed in 2014. Mortality declined by 3.2% annually from 2006 through 2013, then decreased even more rapidly, by 6.3% annually, from 2013 through 2016. Conclusion  These may not be the enormous gains some might expect, but given that lung cancer remains one of the most common cancers in the U.S. with nearly 250,000 cases per year, this progress represents thousands of lives each year. Though we've focused here on lung cancer , similar advancements are transforming treatment for other cancer types as well. As our understanding of cancer deepens, we’re developing drugs with greater precision to target cancer’s unique vulnerabilities, allowing us to combat the disease in ways we never thought possible. Lung cancer research, in particular, is a beautiful showcase of this new generation of therapies that improve survival rates and enhance quality of life. This progress not only saves lives but brings us closer to a future where cancer can be managed with minimal impact on patients’ daily lives. Written by Luis Guilherme

Lung cancer awareness and support events offer invaluable opportunities for patients, survivors, families, and communities to come together, educate, and raise funds to combat lung cancer. North Carolina hosts several impactful events, blending community engagement, education, and awareness. Here’s a look at some of the top lung cancer events in the state, each offering unique ways to get involved, learn, and support those affected by lung cancer. 1. Updates in Lung Cancer: Community Education Event Date: November 7th  from 12:00 p.m. until 1:30 p.m. Location : Atrium Health Levine Cancer Institute Click here for more info This educational event provides the latest updates in lung cancer treatment and research, featuring talks from experts and healthcare professionals. Participants gain a deeper understanding of advancements in lung cancer therapies and current research trends, which are invaluable for patients, caregivers, and anyone affected by lung cancer. It's an excellent opportunity to learn directly from experts about ongoing progress and emerging treatments, making a significant impact on the way communities approach lung cancer care. 2. Jodi Kovach Memorial 5K Date : November 10th Location : Forest Hills Park, Durham, NC Click here for more info The Jodi Kovach Memorial 5K celebrates the life and legacy of Jodi Kovach, who courageously battled lung cancer. This race is a community-driven event with proceeds going towards lung cancer research and support services. Runners, walkers, and families gather in a supportive and fun atmosphere, making it a meaningful experience for everyone involved. Participating in the 5K not only raises awareness but also contributes directly to lung cancer research, honoring those who have been impacted by this disease. 3. Survivor Engagement Event Date : November 14th Location : Online Click here for more info This annual event celebrates lung cancer survivors, bringing them together with supporters for an inspiring day of connection and empowerment. Activities focus on survivor stories, shared experiences, and resources for ongoing support. Events like these foster a strong sense of community, where survivors and their loved ones can engage in meaningful discussions, gain support, and inspire one another. It’s a powerful reminder of resilience and hope, offering survivors a space to connect and thrive. 4. All In to Fight Cancer Raleigh Event Date : November 21, 2024 Location : The Ritz, Raleigh, NC Click here for more info This exciting annual fundraiser event gathers the community for a night of entertainment, awareness, and fundraising for lung cancer and other cancer types. Held at The Ritz in Raleigh, the “All In” event includes live music, games, and opportunities to learn about local cancer initiatives. With a focus on community involvement and support, this event combines fun with purpose, drawing in diverse groups all committed to the cause. Funds raised go directly to support cancer research and patient care, making a difference in the lives of North Carolinians affected by cancer. 5. Hockey Fights Cancer - North Carolina NHL Date : November, 2024 Location : NHL Arenas across North Carolina Click here for more info Hockey Fights Cancer is an annual NHL initiative where hockey teams across the nation, including in North Carolina, raise awareness and funds for cancer patients. Teams wear special uniforms and engage fans with activities that highlight cancer awareness, making it a memorable event for hockey enthusiasts and families. The event showcases the sports community’s commitment to fighting cancer and provides a platform to educate fans on cancer prevention and early detection. For anyone who loves hockey, it’s a chance to support a great cause while enjoying the sport. Each of these events provides unique ways to support and raise awareness for lung cancer in North Carolina. Whether through education, community engagement, or physical activity, these gatherings reflect the dedication of communities and organizations in the fight against lung cancer. By attending, donating, or participating, we can all play a part in bringing hope, knowledge, and support to those affected by lung cancer.

Hearing "you have cancer" In May of 2014 I was told something no one should ever hear, “you have cancer”. The path to write this 10 years later was not linear, it was filled with challenges from my diagnosis Stage 4 NSCLC to negative thoughts such as anger, anxiety, sadness and sorry. I was at the lowest point of my life, but survival was driving everything I did. Life is about momentum and that propelled me to find my path. Joining an immunotherapy clinical trial Because I felt a traditional path of treatment was not for me, I researched clinical trials and found that Duke had one underway for a new treatment called immunotherapy, with a bit of luck I fit the profile of what they needed, non-small cell lung cancer with no mutations. After 14 months of infusions with optivo and yervoy my tumors reduced in size to a point where if they did not grow, I would be considered in remission. I now get yearly MRI/ CT scans to ensure it does not return. Getting treatment was easier than the aftermath For me this was the easy part, the total focus on treatment and survival was the journey. The hard part for me was dealing with the aftermath of the trauma inflicted. Everything was different and the new path was unknown. I was finally able to dwell in the gratitude of having a second chance and the way I found to maintain this good feeling was getting involved in issues I cared about and giving back by volunteering . Exercise and eating well was not enough. Getting involved with Lung Cancer Initiative Getting involved with Lung Cancer Initiative was important for my mental health, I was able to meet other survivors who had gone through a similar experience and hearing their stories about their journeys really put things in perspective for me. It let me know I was not alone and many of their stories were much worse than mine. I know that sharing my story helped others as well.  Cancer research has come a long way in just the last 10 years from immunotherapy to targeted therapy it has helped many survive what 20 years ago would have been a death sentence. The research grants that LCI provides is one of the many ways they support cancer research and the cancer community.

From my personal experience, the similarity between climbing Mount Kilimanjaro and the experience of cancer survivorship is overwhelming .   When you first hear the word “cancer”, the immediate thoughts that run through your mind include “I can’t do this”, “fear”, “overwhelmed”, and “scared” which are recurrent thoughts during different stages of the route to climb Mtn Kilimanjaro. Even the thought of death sneaks into your mind as you assess some of the scary portions of the Kilimanjaro climb, which is certainly a big part of the cancer experience.  Gather your gear list The first phase of preparing to climb Kilimanjaro is gathering your needed gear list.  The first phase of cancer diagnosis has a similar stage:  gathering CT/MRI scan results, lab results, physical exam, and biopsy/pathology results.  Once you have all your information and equipment you are ready to select your route and proceed with the journey. Take one step at a time On the Kilimanjaro climb, you only take one short slow step at a time with all your attention on where you will place your foot for the next step.  Your attention cannot waiver to even enjoy the surrounding scenery for fear of a miss-step.  If you look ahead (i.e., worry about what comes next) the path seems daunting and unachievable but with your head down and focused on each moment, you make the day’s journey one small step at a time.  Our African guides continuously reminded us to “pole, pole” which is Swahili means "slowly, gently, softly, quietly; be calm, take it quietly. Ask for assistance On the Kili climb, you have guides, which advise you and lead you on the correct path at the correct speed.  In survivorship, our guides are our physicians and navigators.  Near the summit it was so cold that at times I needed my guide to help me with the simple task of putting my gloves back onto my hands.  In cancer, you often have to ask for assistance with the simple tasks of life. Get support On the Kili climb, you have porters, whose job is to carry all your needed equipment (tents, food, equipment, luggage, etc.).  In survivorship, we have many resources to help us carry the load – such as oncology nurses and nonprofits. Surround yourself with people who encourage you On the Kili climb, we have our teammates who help encourage, motivate and inspire us each day.  In survivorship, we have our friends and other survivors who play this role. Share the experience Finally, we have our tent-mates on the climb and in survivorship we have our family who are there with us day and night, minute by minute, even when we are weak, tired and dirty – they are there to share our lives and experience. While climbing Kilimanjaro, your body and mind has to continually adjust to smaller amounts of available oxygen as you reach higher altitude, which often leads to fatigue and shortness of breath. The journey through cancer survivorship often leaves you feeling the exact same way! So while both “mountains” seem insurmountable, by taking small slow steps with the help of guides, porters, teammates and tent mates – if you “pole, pole” – then you will indeed reach the summit of whatever mountain you are facing!  So thank you Kilimanjaro for teaching me another valuable lesson regarding life and cancer survivorship! “Pole, Pole ya’ll". About Dr. Chasse Bailey-Dorton Dr. Chasse Bailey-Dorton, MD  is a 21 year breast cancer survivor and the Medical Director of The After Cancer. Her mission is to provide reliable information for someone with a cancer diagnosis, being treated for cancer, recovering from treatment, seeking cancer recurrence risk reduction strategies, or at high risk for cancer.

5 years breast cancer survivor It's hard to believe that I am 5 years out from my initial breast cancer diagnosis. Through all the decisions that I had to make and treatments that I chose to endure, I discovered an inner strength I never knew I had. It was difficult to identify with this "new normal" of being a cancer survivor, considering pre-cancer diagnosis, I led a very active and healthy lifestyle. I had mixed emotions of joy and relief after my last doctor's appointment but also felt anxious and fearful of a recurrence .  Healing my body and mind Slowly, as my body healed, I worked on my mindset to not only survive but thrive in this next chapter of my life. I had to work on replacing the fear and anxiety with more positive thinking. It's been helpful to practice mindfulness and engage in activities that allow me to share my story and feelings. Through this connection with others, I find hope, strength and determination to embrace life more fully. I find joy in the little things and do what I can to share those moments so that others may enjoy it.  How integrative medicine has helped me Integrative medicine has been instrumental in supporting my journey through remission. Embracing a holistic approach has helped me navigate both the physical and emotional aspects of recovery. Here are some lifestyle aspects I recommend incorporating into your life as your body allows: Nutrition :  Focus on fueling your body with healthy foods such as lean meats, whole grains, fresh fruits, and vegetables to support overall health and recovery. Physical Activity:  Engage in regular physical activity that matches your energy levels and physical capabilities. Setting and achieving personal goals, like qualifying for a marathon, can be incredibly empowering and beneficial for your overall well-being. Complementary Therapies:  Consider integrating complementary therapies such as acupuncture or massage therapy. These can help manage stress, alleviate symptoms, and enhance your overall sense of well-being. Stress Management:  Practice stress-management techniques such as mindfulness, meditation, or yoga. These practices can help maintain emotional balance and reduce anxiety related to remission. Sleep:  Ensure you prioritize good sleep hygiene. Adequate rest is crucial for healing and maintaining your physical and emotional health. Relationships:  Cultivate and nurture supportive relationships with friends, family, or support groups. Positive social connections can provide emotional support, encouragement, and a sense of community. By incorporating these practices into your daily routine, you can support your ongoing journey through remission and enhance your overall quality of life. Fortunately today, I am in remission but I know that is not synonymous with a cure. I focus my mind to appreciate what each day brings and do what I can to feel at peace and spread that feeling to others. I am grateful to be thriving and leading a very fulfilling life. About Dr. Maria Cayelli Dr. Maria Cayelli, MD , is Board Certified in Family Medicine and trained in Integrative Medicine. She's part of The After Cancer Care Team  and she assists patients in exploring the best of modern medicine as well as evidence-based complementary therapies to empower them with individualized medicine.

Surgery is a Standard Component of Treatment for Most Breast Cancer Patients Surgery is often used in combination with other forms of treatment, which may include chemotherapy , immunotherapy, endocrine therapy, and radiation therapy . Sometimes surgery is recommended before other therapies. In other circumstances, chemotherapy will be recommended before surgery. This decision depends on the specific subtype of breast cancer as well as the breast cancer stage among other factors. Surgery involves removing the breast cancer with an operation and oftentimes involves surgical evaluation of the lymph nodes under the arm. In most scenarios, there are two options for surgery: breast conserving surgery or mastectomy.   Different Surgical Options: Breast Conserving Surgery, Mastectomy, and Axillary Lymph Node Surgery Breast conserving surgery Breast conserving surgery (BCS), also known as lumpectomy or partial mastectomy, is surgery to remove breast cancer and a small amount of normal, healthy breast tissue that surrounds the cancer. The goal of BCS is to remove all the breast cancer and preserve the remaining health breast tissue. BCS is an option for most early-stage breast cancers. Studies indicate that BCS followed by radiation therapy results in equivalent survival and is as effective in preventing a recurrence of breast cancer as removal of the entire breast (mastectomy) for early-stage breast cancer. It is important to understand that not every breast cancer patient is a candidate for BCS. Specifically, patients with large cancers, multiple cancers, prior breast or chest radiation, specific genetic mutations, or history of a chronic inflammatory conditions such as systemic lupus erythematous or scleroderma may not be good candidates for radiation. In BCS, patients retain most of their breast tissue including the nipple in most scenarios as well as sensation to the skin of the breast.   Mastectomy Mastectomy is a surgery to remove the vast majority of tissue from a breast, including the cancer site. Classically, a mastectomy includes removing the breast tissue as well as breast skin and the nipple. In these settings, closure is generally performed by the breast cancer surgeon in a flat fashion. More recently, newer surgical techniques allowed for preservation of the breast skin and nipple. In these settings, surgery is most commonly performed in conjunction with a reconstructive plastic surgeon. It is important to know that the reconstruction may involve more than one surgery. Patients may elect to have removal of just the breast with cancer in it, which is called a unilateral mastectomy, or they may elect to have both breasts removed, which is called a bilateral mastectomy. In many cases, patients that undergo mastectomy for the breast cancer may not require radiation. Scenarios where radiation may still be recommended are if there is cancer in the lymph nodes, the tumor is very large, or if there is cancer at a margin on the mastectomy specimen. It is important to understand that a mastectomy, even with reconstruction, is different from a breast augmentation. Sensation to the breast skin and nipple will be permanently altered. In most scenarios, a drain will be placed as well to prevent fluid accumulation. The drain tubes are sewn into place, and the ends are attached to a small drainage bag or bulb. These stay in place about 7-14 days on average and help speed the healing process.   Axillary lymph node surgery The first place that a breast cancer spreads in most cases is the lymph nodes that live beneath the arm in a space call the axilla. Surgical evaluation of lymph nodes is a common secondary component to breast cancer surgery. For many breast cancers, the surgical team may recommend a “sentinel lymph node biopsy.” In this procedure, the surgeon will remove between 1-4 lymph nodes. These nodes will then be sent to the pathologist (another physician) who will assess the lymph nodes under the microscope to make sure that the cancer has not spread. If a patient elects to proceed with BCS, a separate small incision is usually required to access the lymph nodes. If a patient is undergoing a mastectomy, usually no additional incision is required. Sometimes, if the cancer has spread to the lymph nodes, a “complete axillary dissection” may be recommended. This involved removal of more lymph nodes from the same area.   How to Prepare for Breast Cancer Surgery Before surgery, patients meet a breast cancer surgeon. The surgeon explains treatment options and what to expect from surgery. Patients can prepare for this meeting by creating a list of questions to ask. Below are some examples: What are options for breast cancer surgery? How much breast needs to be removed? What are the options for reconstruction? Can the reconstruction be started at the same time as the cancer surgery? How will the breast look after surgery? Will the breasts look the same? How much time will be spent in the hospital? How much time is needed for recovery? What are the activity restrictions after surgery? When is it safe to return to work? Additionally, optimizing sleep , nutrition , and emotional well-being before surgery can benefit the recovery process.   What to Expect with Breast Cancer Surgery For BCS, patients generally spend about a half day at the hospital before going home (“outpatient surgery”). Patients meet with the nursing staff, the anesthesia team, and the surgeon prior to going back to the operating room. In many cases, patients also will need to meet the radiology team to have the cancer “localized” prior to surgery. Localization means that the radiologist will place a wire or device into the cancer location so that the surgeon can find it easily in the operating room. The surgery itself lasts between 1-2 hours and then patients will recover in the post-operative recovery area prior to being dismissed to go home. For mastectomy, patients will either be able to go home the same day or may stay in the hospital overnight, depending on your surgeon and hospital’s policies. Like with BCS, mastectomy patients will meet with the nursing staff, the anesthesia team, and the surgeon prior to going back to the operating room. The mastectomy itself is variable in terms of time and depends on if the case unilateral or bilateral, if it is skin-sparing or nipple-sparing, and if there is a reconstruction portion with the plastic surgery team. For either surgical approach, patients will need to stop eating prior to the surgical date. In most cases, a patient will be asked to not eat after midnight before surgery. It is also very important to inform the healthcare team about any medicines, vitamins, or supplements being taken as these can sometimes interfere with the surgery. In many scenarios, patients will be asked to stop their blood-thinning medications to decrease the risk of bleeding. It is also very important to arrange a transportation plan for after surgery, as patients who have undergone surgery are generally recommended against driving for a period of time. After surgery, the surgical team will call once the final pathology results are available. This takes about 1-2 weeks.              Risks of Breast Cancer Surgery While breast surgery is overall lower risk than many other surgeries, there are still some risks of which to be aware: Bleeding. For BCS or mastectomy, this presents usually within 24 hours after surgery. Large swelling, increased pain, and bruising are signs and symptoms to watch for. Rarely, the surgical team has to take a patient back to the OR to stop the bleeding. Collection of fluid at the operative site, called a seroma. Infection. Pain. Scar. Anytime an incision is made in the skin, a scar will be present afterwards. Problems with wound healing. Risks related to anesthesia include confusion, nausea and vomiting. For lymph node surgery, patients may notice a change or loss of sensation on their inner arm and potentially arm swelling (called “lymphedema”) Positive margins. It is possible that the surgeon may recommend returning to the OR to remove more tissue if cancer is close or involving one of the margins after surgery. About Dr. Robert Pride Dr. Robert Pride is a breast surgical oncologist specializing in breast cancer, high-risk breast lesions, and benign breast disease. He was a Division I athlete at Dartmouth College before attending the University of Central Florida College of Medicine for medical school . He completed his general surgery residency at the prestigious Mayo Clinic in Rochester, MN. He then completed fellowship training in breast surgical oncology at the Harvard Medical School hospitals in Boston, MA which included Massachusetts General Hospital , Brigham and Women's Hospital , and the Dana Farber Cancer Institute . He has published numerous articles and book chapters about breast disease and has presented at several major national breast conferences. He was born and raised in Colorado and joined Western Surgical Care in 2023. He practices at Sky Ridge Medical Center in Lone Tree.

Discovering my family's BRCA 2 mutation In April 2023, I clutched my father’s hand in a sterile surgical waiting room, as a doctor informed us that they found a tumor in my mother’s fallopian tube. It had tested positive for ovarian cancer. During her diagnostic process, we discovered that my mother carries the BRCA 2 mutation and, thus, it was recommended that all blood relatives undergo testing as well. Six weeks later, on my 39th birthday (and two days before my mom was scheduled to begin chemo), my results arrived. I, too, carried the same mutation. At the time, I was nine months postpartum with my son and my two daughters were 7 and 5. I worked full time, my family was spread out all over the country, and my world was crumbling around me. Life as I knew it, would never be the same And it wasn’t.  Given my age and that I had no plans to have additional children, every doctor I met with recommended a prophylactic double mastectomy and a hysterectomy/bilateral salpingo-oophorectomy (BSO). The reality that the same reproductive organs that had nurtured and brought my perfect baby boy into the world could now pose a potentially life threatening  risk was difficult to comprehend. The removal of my ovaries also meant facing certain and immediate menopause ; a phase of life I had yet to even consider. After a few agonizing weeks of feeling afraid and sorry for myself, I decided to turn the negative energy into something productive.  I started by gathering information. I met with every doctor possible: gynecologists, primary care physicians, breast oncologists, gynecologic oncologists, general oncologists, and all kinds of surgeons. I did every exam recommended: mammograms, MRIs, bone density scans, skin checks, vision checks, blood work after blood work after blood work. I connected with genetic specialists in North Carolina, hormone experts in Israel, menopause care providers in New York, and fem health leaders in Amsterdam. I admit that this sounds overboard but I took comfort in my proactiveness. I needed to feel armed with information before making any decisions about my body.  Talking with others In time, I told my inner circle what I was up against and started accepting offers to chat with other women who had been in my position. I found that the women, often complete strangers, speaking from their own experience was more impactful than meeting with the doctors. They were able to acknowledge the pain that comes with the uncertainty of this diagnosis and laid out how they were able to make their own decisions with regard to surgery selection, timeline, and recovery management. They shared examples of how their bodies reacted to the surgeries, how they got through the emotional rollercoaster, and what their life was like now having been through it.  Nothing Pink Somewhere along the way, I discovered NothingPink . This local organization offers support to people at high risk of hereditary breast and ovarian cancers. Among their many programs, NothingPink hosted monthly zoom support groups where we could come together to share experience and advice with women at various stages of their preventative journeys. There were many sessions where I cried the whole time or had to log out early because it all felt so overwhelming.   Eventually, the anxiety of it all was too much to bear. Every pain, bubble, or tinge that was somewhat near my abdomen had me convinced that the “silent killer” was coming for me next, so I accelerated my timeline. Six months after my mother’s diagnosis and the week of her last chemo treatment, I had my hysterectomy/BSO. Three months later, in January 2024, I had my double mastectomy, an unplanned procedure from a minor complication in February 2024, and my final exchange surgery in April 2024. Throughout each surgery, the NothingPink army was along for the ride. They provided detailed advice on what to expect before, during, and after surgery while serving as a constant reminder that I had a team of women cheering me on.  Taking control of your health I was able to get through the surgeries knowing that I had a privilege that many others did not. I was able to choose. I could take control of my health and mitigate risks on my terms. While I knew the surgeries would be hard on me and my family, I saw firsthand how much harder it is to recover from surgery  and  undergo cancer treatment. I knew I had so much to live for and, when I needed a reminder, I would hug my kids, snuggle my dogs, and admire my doting husband. They needed me and they needed me healthy. Equally important, I saw it as a profound opportunity to model courage and strength for my children who might one day have to face a version of this journey as well. I wanted them to see their mommy as a fighter.  And they did.  Going back to "normal" Today, I’m back to my “new” old self, but with a sharper focus on what truly matters and the people who are most important. I’m exercising daily, traveling the world, lifting my children high in the air, and paying it forward whenever the opportunity arises.  When I stumbled upon posts like this one - often in the middle of the night, wide awake with worry and fear - I craved advice, hope, and a dose of positivity. With that in mind, here are a few things that worked for me:  I allowed myself to be vulnerable and connect with anyone willing to share their experience and advice. I spoke with friends of friends of friends, neighbors, coworkers, grandmothers — literally ANYONE. If they were willing to make the time for me, I made the time to listen to and learn from them. I took something away from every single conversation. I researched, studied, examined, and ADVOCATED . I realized that the surgeons do this day in and day out but the area specialists have unique insight and detail - be it genetics, hormones, menopause care, or risk management. I figured out what the important questions were for me to ask and made sure I always had clear answers. When they weren’t clear, I sought out other ways to get the information I needed.  Community.  The NothingPink organization and the FORCE message board offered firsthand experience and support in a way that only women who have been through it can. They were open, honest, and offered unique insight into this all-consuming shared experience. Empowered women empower women.  Asked for help.  When I was ready, I allowed myself to accept outside support. People from all walks of my life showed up in ways I never could have imagined. My neighbors organized a meal train, my friends took my kids on playdate adventures, our children’s school delivered groceries to our front porch - I was in awe. Our extended family took turns rearranging their lives to be there for us in our darkest hours, sometimes with 24 hours notice. The pain and loneliness slipped away with each and every act of kindness. Gratitude.  Despite everything, I had so much for which to be grateful. Unlike my mother, I was in the driver’s seat. I was so afraid that my kids would be scarred for life seeing their mommy down and out but they adapted (almost too) easily. They played barbies in my bed or read books snuggled next to me. Oddly, my six year old loved helping me clear out my mastectomy drains. My husband was the ultimate teammate on this journey, the best friend I could ever ask for, and the rock of our family. I loved him more and more every single day of this experience and still can’t believe the lengths he went to to show the depth of his love for me.  I took things one day at a time.  You can only do what’s right in front of you. Some days I researched until my eyes watered from staring at my computer screen and my throat hurt from talking so much about my situation. Other days, I lost myself in work or playing with my children. I took each surgery as it came, prepped as best as I could, recovered as patiently as possible, regained my strength wherever possible, and proved to myself that if I can do this, I can do anything.  And I can.  About Marissa Bailey Marissa lives in Charlotte, North Carolina with her three children (Olivia, Emma, and Cameron) and her two doodles (Mila and Kaia). After years of working in media and entertainment, she is taking a professional break to focus on the next phase of her recovery: prioritizing her physical, emotional, psychological, and spiritual growth. As she starts thinking about her next chapter, however, she is confident it will involve supporting and empowering women.

Inevitable physiological changes As women, when we enter our 40s we start to mentally prepare for the inevitable physiological changes that await us in the upcoming years. We’ve known since we started getting our periods as teenagers that someday down the line, we’d eventually stop getting them. Those with particularly uncomfortable periods may have even looked forward to this day, not realizing that the transitional time of perimenopause can bring on even worse symptoms. Perimenopause Perimenopause literally means “around menopause,” referring to the time when our bodies prepare to enter menopause, the official end of a woman’s reproductive years. During perimenopause, our periods may become irregular, but it’s not until a woman has stopped getting her period for 12 consecutive months that she is considered to have reached menopause. Drop in progesterone Though perimenopause typically begins in our 40’s, for some women it can start earlier. During this time, estrogen (the predominant “female” hormone) can fluctuate, as can ovulation, and we may experience menopausal symptoms such as insomnia and hot flashes . But the first sign of perimenopause is usually marked by a drop in progesterone. Estrogen Dominance This drop in progesterone during perimenopause can lead to estrogen dominance (this does not mean estrogen is abnormally high, but rather, high in relation to progesterone levels). Estrogen dominance can cause irregular periods, not only in terms of frequency, but also in length and heaviness. Estrogen dominance can cause a host of other unpleasant symptoms and more serious conditions, including cyclical headaches, weight gain, mood swings, brain fog, insomnia, fibrocystic breast tissue, uterine polyps or fibroids, and even an increased risk for breast cancer. [Source: Biomedicine & Pharmacotherapy 102 (2018) 403-411] It’s no wonder that, for as much as we “can’t wait” to stop menstruating, we quickly begin to dread perimenopause, and for good reason – heavy periods, irritability, and insomnia ?! It’s not much fun, and to make matters worse, it can last up to 10 years! The symptoms of perimenopause are well documented, but the remedies are not. I want you to take comfort in knowing that this transitional time is not something to dread - it can be managed, especially if we care for ourselves and get on top of perimenopausal symptoms. 3 Key Strategies for Perimenopause Since many of the unpleasant symptoms of perimenopause can be traced back to low progesterone, the key to braving perimenopause is to create a healthy diet and lifestyle that naturally boosts progesterone and helps balance estrogen. To do this, there are three lifestyle factors that are essential to address. 1. Get serious about managing stress Perimenopause often hits at a time when we are already overwhelmed with our career and caring for children or aging parents (or both). At this stage we are prime for irritability, and the last thing we need is to add more irritability, sleep disturbances, and heavy periods into the mix. Perimenopause can do just that, and stress makes symptoms worse. Progesterone is produced in both the ovaries and the adrenal glands. Cortisol (our stress response hormone) is also produced in the adrenals, however, cortisol takes priority in the hormonal hierarchy. When we are under stress, the adrenal glands will prioritize the production of cortisol at the expense of progesterone. During perimenopause, when progesterone is already low, stress can cause progesterone to fall even lower. Taking steps to reduce your stressors, prioritizing self-care , and really looking at your reaction to stress and how you can improve it will make a huge difference here. Working with a trusted Coach can help you identify your stressors, set boundaries, and reframe how you view and handle stress, in turn, helping to reduce stress’ impact on your body. 2. Detox estrogen When your digestive system is functioning properly and you have a healthy gut microbiome, excess estrogens are metabolized by the liver and excreted from the body. There are many factors that can inhibit this process, however, and cause estrogens to be reabsorbed. This can further disrupt the balance of estrogen and progesterone and lead to more symptoms of estrogen dominance. Establishing a healthy gut and a diverse microbiome is key to moving estrogens out of the body and keeping them from being reabsorbed. When most people think about a healthy microbiome, they think about taking probiotics. Probiotics can certainly help, but there is often more that we need to do to heal the intestinal lining and create a healthy diet that feeds our beneficial bacteria. Working with a healthcare practitioner or Coach who understands both gut health and hormonal balance can really help here. It’s also important to reduce your exposure to xenoestrogens - chemicals that mimic estrogen in the body and bind to estrogen receptors. Some xenoestrogens include BPAs, found in plastics, and phthalates and parabens, which are found in personal care products like shampoo, deodorant, lotions, etc. Exercise can also help remove excess estrogen, while at the same time, produce more beneficial estrogen metabolites that can help prevent breast cancer. Exercise helps toxins move out of the body. 3. Prioritize sleep Quality sleep is essential for hormone balance. We naturally produce the most melatonin between 11pm and 2am while we’re sleeping, so getting to bed early has great health benefits. Melatonin lowers estradiol levels and helps with the overall balance of estrogen and progesterone. However, getting more sleep can be a challenge when we’re trying to juggle career, family, and staying on top of our health. There just never seems to be enough time in the day! As a result, many of us may even engage in a form of self-sabotage referred to as Revenge Bedtime Procrastination , forgoing sleep in order to have free, quiet, or alone time. That blissful time after the kids are asleep and all the chores are done may feel like the only time we have to unwind, but when we sacrifice our sleep, for any reason, we wind up doing ourselves a great injustice. One of the best things you can do for yourself is prioritize sleep. Establishing a sleep routine may be necessary at first, until it becomes a regular habit. Just as children have a “winding down” routine (snack, bath, story book) before it’s time for bed, adults are no different. Your routine may include turning off all electronics an hour before bed, taking a bath, drinking herbal tea, and/or reading a chapter from your favorite book. Start to train your body that it’s time for bed, and pretty soon you’ll reap the benefits of more restful sleep. What I want you to take away from this is that, while perimenopause is inevitable, the discomfort associated with it is not . Often when we feel there is nothing to be done, we resign to the symptoms and become complacent. However, complacency is an enemy to health. We don’t have to live with all of these symptoms. By proactively making the time and effort to attend to our diet, lifestyle, and supplementation, we are able to navigate and manage perimenopause naturally and smoothly. About Merritt Tracy Merritt Tracy  is a National Board Certified Health and Wellness Coach. Her mission is to empower women to live a healthy and happy life, naturally balance their hormones, and prevent cancer or a recurrence of cancer.

For as long as I can remember, cancer has impacted my life. When I was a kid, my grandmother was fighting breast cancer. I remember playing dress-up in her room – she had a closet full of clothes, shoes, jewelry and purses. My cousins and I always loved playing there. One day my mom came in as one of my cousins was prancing around the room sporting fake boobs and high heels. We were having a blast, but my mom was horrified and angry. The fake boobs were my grandmother’s prosthetic breasts that she needed because of the double mastectomy. My mother’s reaction to our innocent playtime was a projection of her own fear and she instilled that fear in me early on. Those fears weren’t unfounded. When I was in high school, I lost my grandmother to metastatic breast cancer and my great grandmother to ovarian cancer. When I was in college, my aunt was diagnosed with both ovarian and uterine cancer. When I was in my thirties, my mom was diagnosed with breast cancer and just a few years ago when I was 50, she was diagnosed with breast cancer for the second time. From worry to wellness I spent a good bit of my life worrying about my risk of cancer. I could see the train barreling down the tracks and it seemed to have me in its sights. Then one day I heard someone say, “Worry is a waste of energy. If you are consumed by worry, there are two things you can do to overcome it. You can let it go or you can do something about it.” I realized then that I needed to do both of those things. I needed to let go of the fear, and I needed to take action. Shifting my mindset to focus on the things I could control to reduce my risk was a pivotal moment for me. I was able to let go of my feelings of helplessness and instead embrace a sense of empowerment . I started eating healthier and I found that I truly enjoyed eating cleaner, fresher foods. I made a conscious effort to slow down and reduce my stress . I learned about endocrine disrupters and reduced my exposure to environmental toxins . I became fascinated with hormone health and gut health. I did a lot of soul-searching and self-discovery. With every step I took, I felt better physically, emotionally, and even spiritually. Sharing it with others I enjoyed the wellness journey so much that I started exploring ways I could share what I had learned with others. I completed my training at the Institute for Integrative Nutrition to be a Health Coach and went on from there to become a National Board Certified Health and Wellness Coach . For nearly twelve years, I have been seeing clients who want to find balance in their lives and hormones and prevent and recover from cancer by lowering their stress and improving their diet and lifestyle. I am happy to be in a place where I can help others strengthen their bodies and minds so they too can let go of worry and take action. About Merritt Tracy Merritt Tracy  is a National Board Certified Health and Wellness Coach. Her mission is to empower women to live a healthy and happy life, naturally balance their hormones, and prevent cancer or a recurrence of cancer.