After Breast Cancer, Many Women Lack Options

Women diagnosed with an early stage of breast cancer face enough tough decisions, like choosing between prolonged therapies or major surgery. Yet, new research indicates doctors aren't even talking about every option available to women before a decision on how to proceed is made.
A new survey reports only one out of three breast cancer patients said they had talked with their doctors about plastic surgery options to reconstruct a lost breast.
The study, published in the Journal of the American Cancer Society, surveyed nearly 1,200 early stage breast cancer patients in Detroit and Los Angeles. The women who learned about breast reconstruction were four times more likely to choose mastectomy over lumpectomy.
Rebecca Larson, 31, was diagnosed with breast cancer in 2006. "I had no idea what my options for reconstruction were at diagnosis, or even before the first mastectomy," Larson said.
"No one talked to me, and my plastic surgeon was left out of the loop until well after the initial surgery," she added.
Cut out the tumor and get radiation, or get a mastectomy and remove the breast. Both treatments have high five-year survival rates. Both come with their own trade-offs of time, self-esteem and peaces of mind, experts say.
Doctor's Discussion
The popularity of breast reconstruction surgery nationwide shows inconsistencies within geographic regions. In Hawaii, 8 percent of women who get a mastectomy have immediate reconstructive surgery. In Iowa, the figure is 11 percent; in New Mexico, it is 22 percent.
"If you think of it, women aren't that different," said Dr. Amy Alderman, lead author of the reconstruction study in cancer, and a plastic surgeon at the University of Michigan Medical Center.
Alderman's research tries to determine if surgeon preferences, rather than patient preferences, are driving reconstruction disparities. She thinks the wide variations in plastic surgery rates may come from regional medical communities' attitudes toward breast reconstruction.
Breast surgery attitudes have long influenced women's treatment options.
The conversation between a surgeon and a breast cancer patient has been considered so crucial by public health advocates, that several states passed laws 20 years ago to standardize it.
In Pennsylvania, women must sign an informed consent waiver, stating they have discussed all treatment options before proceeding with their surgery. Previous laws tried to change the habit of performing mastectomies in favor of lumpectomies, which give some women a chance to keep more breast tissue.
Today, lumpectomies make up 65 percent of early stage breast cancer treatments, according to Dr. Freya Schnabel, director of breast surgery at New York University Medical Center.
Now, experts think the missing conversations might be about immediate breast reconstruction after a mastectomy, a procedure that combines a mastectomy and plastic surgery in one longer operation.
In 1998, Congress passed the Women's Health and Cancer Rights Act, which forced health insurance companies to cover reconstructive breast surgery for all mastectomy patients, for life.
Lillie Shockney, administrative director and assistant professor at the Johns Hopkins Breast Center, testified before Congress in support of the bill.
At the time, Shockney contacted 16 insurance companies to see if they covered testicular implants after testicular cancer, and they all did.
In her testimony, she recalls saying, "I said, 'gentlemen, it's our turn; I can't see what you've got down there, but you can see what I've got up here."
Importance of Choice
Provided a woman is a good candidate for the five-hour-long reconstructive surgery, immediate reconstruction can save a patient a second round of a four-week recovery after breast surgery.
Some women elect to have mastectomies, when a lumpectomy is an option, because they don't want to carry around the worry. Patients often say, "I'm not going to trust that, I want the breast off," said Anne Rosenberg, clinical professor of surgery at Thomas Jefferson University Hospital.
For women who choose mastectomy, or for women who had no choice, providing immediate breast reconstruction surgery for all eligible women might be a difficult challenge.
One factor might be the limited surgery resources of an area, says Rosenberg.
Reconstruction requires a general surgeon to find a consulting plastic surgeon and to coordinate operation time — a difficult task for a stand-alone general surgeon with a private practice.


source-http://abcnews.go.com/Health/OnCallPlus/Story?id=4039080&page=1

by--------
Dermatology Centre

Men Carry Breast Cancer Genes, Too

se genes and had told their male kin the results.

Six men said they hadn't been told, or had forgotten. Of the other 18, two mistakenly said the test had been negative. Seven did not think the results revealed anything about their own cancer risk. Only five understood they, too, might carry the genes.

Of the six who expressed any interest in being tested themselves, three said they were doing so mostly for their children's sake.

"We try to reach out to the men in these families, particularly men who have little children," Daly said. "If they were to die without being tested, their children would grow up without that information" that they, too, were at risk, she said.

Dr. Steven Vogl, a cancer doctor in private practice in New York, said he recognized that potential when his neighbor was dying of lung cancer and told him how many female relatives had suffered or died of breast and other cancers.

"Being a good doctor, I took a history," and realized the man, an Eastern European Jew, probably had the gene.

"At least it will help his granddaughter" to know of the risk, Vogl said.

Women, too, need to realize they are doing male relatives and their descendants a favor when they reveal their own genetic risk from BRCA genes.

"They don't realize they are at risk," or that their grandchildren may be, Daly said.

On the Net:

Breast cancer meeting: www.sabcs.org

National Cancer Institute: www.cancer.gov

American Cancer Society: www.cancer.org

Resource---- http://news.aol.com/story/_a/men-carry-breast-cancer-genes-too/n20071215050909990001?ecid=RSS0001
by-------- Dermaology Centre London

Is a Younger Looking Face in Your Future?

Ever stand in front of a mirror and wish that the image looking back at you didn't look so tired? So old? In fact, you probably are beginning to realize that the tiredness you are seeing is not going away even though you get plenty of sleep, eat well and exercise regularly.

Maybe you realize that you have mistaken the look of droopiness for tiredness and have begun pushing your face upward at the sides just wishing that the sagginess was less apparent.

Most of all, you wish that as you study your face, it would stay up and back without positioning your fingertips near the hairline. In fact, you probably wish you didn't look so tired, drained and old.

The once subtle changes of aging are now blatant and you want that stopped.

An old looking face can sap your self confidence. It's no secret that if you look older than your years, your eyes won't seem bright or twinkling and no matter what you choose to wear, most likely you will feel frumpy all day.

Owning this feeling of frumpiness will assure you that the day most likely will be fraught with challenges because you aren't operating at the top of your game and those feelings of inadequacies can spill over to many areas of our lives.

Maybe you have stopped at the department store cosmetic counter to buy a little something that would cheer you and instead of being shown the latest deep purple, almost black nail lacquer, the saleswoman steers you towards the anti-aging creams and serums.

This action repulses you and you want to scream that you bought that item a month ago and it's still not working. You want something that makes a visible difference in your appearance – not another cream or a cover-up.

If your entire bathroom vanity if filled to the brim with drawers of half used products that promise to plump, disguise and diminish lines and wrinkles you are not alone.

The cosmetic industry is a multi-billion dollar a year business because women demand to look beautiful.

Not only do women rely on the cosmetic industry, they also have begun to believe that injections and surgery are the next logical steps to forego an aging face since plastic surgery, strings, injections and the like have become mainstream alternatives. These alternatives are not remedies.

A young looking face is a result of healthy, strong facial muscles.

Injecting the facial muscles with paralyzing toxins or plumping serums will not make those muscles stronger.

Cutting healthy tissue and suturing it will not make the muscles stronger.

There is only one way to make certain your facial features look young and that is by using specialized exercises that employ resistance and contraction movements.

Developing stronger facial muscles better supports the skin. Exercise provides the skin increased oxygen and circulation that makes it act, feel and look younger and thicker.

How long does it take to see results? Results are usually seen everyday. From the inside out the muscles are re-energized and day by day, the eye brows lift, the cheeks tighten and the double chin melts away.

The facial muscles are connected to bone on one end; the other end is connected to either the skin or another muscle. The muscles also weave over and under each other and because of this, special anchoring techniques are required to fully exercise facial muscles.

Without the anchoring techniques the muscles do not contract. Without contraction the muscles cannot lift or reposition.

Grimaces that squish the face, contortions and twitches will not produce the facelift you desire. There are no miracle topical creams, lotions or potions.

The best avenue to stop aging so that you look healthier and younger is as simple as using your thumbs and fingers as your age erasers. Without pain, recovery time, disappointment, injections or surgery, you can look years younger in hardly anytime at all. Recapture that younger face that you thought was gone forever.

source::::::::::http://www.americanchronicle.com/articles/viewArticle.asp?articleID=45826

By---------Dermatology Clinic

FACE-TRANSPLANT PATIENT 'SATISFIED'

A French woman who two years ago became the first person to receive a face transplant has recovered with remarkably good aesthetic results and has gradually regained normal skin sensation and control of her facial muscles, doctors reported yesterday in the first detailed account of her progress.
Isabelle Dinoire, who at age 38 lost her lips, cheeks, chin and most of her nose when she was mauled by her dog, now blends into crowds and attends parties comfortably with the face she got from a 46-year-old brain-dead donor. Surgeons attached the face like a mask in a landmark 15-hour surgery.
Her recovery, however, has at times been harrowing, her surgeon, Jean-Michel Dubernard, acknowledged. Twice her immune system has mounted violent reactions against the new tissue, one of several anticipated risks that had led some experts to question the wisdom of the surgery. The immune-suppressing drugs she must take for the rest of her life have also wreaked havoc, causing infections and, at one point, kidney failure.
But Dinoire is "very satisfied" with the outcome, the medical team reports in today's issue of the New England Journal of Medicine. And although some experts remain uncomfortable with the experiment, including its lack of psychological follow-up, some who were initially critical of the attempt said they are impressed.
"They proved me wrong," said Peter Butler of the Royal Free Hospital in London, who has been organizing a slower-paced effort to transplant faces in England. "Her neuromuscular recovery looks good. She's done extremely well."
The circumstances of Dinoire's injury remain mysterious. She was unconscious when her dog chewed off much of her face on May 28, 2005. Some have suggested she had tried to take her own life, though Dubernard, of Lyon University, has said she merely took a sleeping pill and may have stumbled and startled the animal.
Whatever the cause, the injury was devastating. Lipless and lacking key muscles, Dinoire could not speak and was fed through a tube.
At the time, teams in several countries were developing controversial plans to transplant faces, raising concerns among ethicists and others that a race to be first was underway. Critics said the risks -- including the possibility of total rejection, leaving the person worse off than before -- were not justified to fix a non-life-threatening injury. Others wondered about the psychological impact of wearing another's visage, given the personal and cultural import of the face as a core element of identity.
But with Dinoire's consent, much of the donor's face -- a triangular swatch of skin, including lips, muscles, nerves and blood vessels -- was microsurgically attached on Nov. 27, 2005. The new report covers the first 18 months of recovery.
In one clear failure, an experimental infusion of bone marrow stem cells from the donor failed to make Dinoire's immune system tolerant of the graft. Despite immune-suppressing drugs, rejection reactions developed 18 days after transplant and again six months later. That necessitated use of more potent suppressant drugs, which led to herpes and pox virus infections.
The infections responded to medications, but the drugs led to blood problems and kidney failure, which required other treatment changes. She is now getting an experimental therapy in the hope of preventing further rejection.
Meanwhile, Dinoire learned to make expressions, eat and drink and enunciate. A video shows her progress, and photos show that with makeup, there is virtually no evidence of the trauma.

source---------http://www.washingtonpost.com/wp-dyn/content/article/2007/12/12/AR2007121202012.html?hpid=moreheadlines

by---------Dermatologist London

GENE STUDY HELPS EXPLAIN LINK TO BREAST CANCER

More than 10 years ago, scientists discovered that mutations in a gene called BRCA1 lead to a particularly deadly type of breast cancer. Now an international group of researchers has found at least one reason why. BRCA1 inactivates a tumor suppressor gene known as PTEN.

Mutations occur spontaneously, but most organisms have mechanisms that can prevent the damage they might cause. PTEN has instructions to produce a protein that stops the uncontrolled cell growth of cancer. BRCA1, the scientists reported online Sunday in Nature Genetics, prevents PTEN from doing its work.

The researchers found that inactivating the PTEN gene in mice led to the formation of the malignant tumor associated with BRCA1 mutations. Then they examined PTEN in nonhereditary breast tumors from 297 patients and tumors from 34 women who had inherited the BRCA1 mutation. In most cases, the protein that PTEN produces was undetectable in tumor cells, but clearly present in nearby normal cells.

PTEN might be a target for chemotherapy. “I am cautiously optimistic,” said Dr. Ramon E. Parsons, the lead researcher and a professor of pathology at Columbia, “that within the next five years we’ll be using drugs that are effective on the PTEN pathway.”

Women with BRCA1 mutations are at very high risk for breast cancer at an early age. Those who know they carry the mutation sometimes choose preventive mastectomies.

Source-

http://www.nytimes.com/2007/12/11/health/research/11lab.html?ref=science

High Rate of Failure Estimated for Silicone Breast Implants

By GARDINER HARRIS

WASHINGTON, April 6 - In documents made public on Wednesday, health regulators estimated that up to 93 percent of silicone breast implants ruptured within 10 years. The surprisingly high figure will further roil a debate next week about whether to lift the 13-year-old ban on silicone implants for breast enhancement.

A committee of plastic surgeons and other experts will convene on Monday to sort through studies of the safety and resilience of silicone implants. The panel is also widely expected to hear emotional testimony from scores of women who have had the implants.

The experts are to decide by April 13, the last day of the hearings, whether the implants are safe enough to be approved for wide use. The Food and Drug Administration then decides whether to follow the recommendation.

The panel voted, 9 to 6, in October 2003 to approve silicone implants. In an unusual move, its chairman later wrote a letter to the F.D.A. urging that it reject the recommendation. The agency sided with the chairman and ruled that more information was needed about long-term safety.

The crucial issues are how often the implants break, what happens to the silicone when they rupture and what health effects result. In the late 1980's and early 90's, thousands of women said ruptured implants had caused myriad connective-tissue and autoimmune diseases that included multiple sclerosis. The assertions bankrupted Dow Corning, a large maker of implants.

An expert committee of scientists found in 1999 that there was little evidence that silicone implants caused such diseases. Instead, the primary safety concern, the panel found, was the tendency of silicone implants to cause local complications like infections, pain and scarring.

Critics have continued to insist that silicone implants are dangerous. Organizations of plastic surgeons and companies like Inamed and Mentor that make implants contend just as vigorously that they are safe.

Underlying the scientific issues are deeply emotional questions about self-image. Physicians are allowed to use silicone implants for women who need reconstructive surgery after major illnesses like cancer. Broader approval would most likely accelerate the growing popularity of breast-enhancement operations.

Some advocates believe such operations should be discouraged. Others say larger breasts can provide women with important help for self-esteem.

The panel will not resolve this debate. Its task is to assess safety, and that will be hard enough. The F.D.A. provided the panel with wildly varying estimates of just how often implants rupture.

Inamed studied its implants for four years and found that 9 percent a year rupture. Those numbers are fraught, however, because most patients have no idea when their implants rupture, and imaging tests are accurate in assessing failures only about two-thirds of the time.

Projecting the numbers over 10 years called for even more guesses. If one assumes that implants are no more likely to fail in their 10th year as they are in their first, just 21 percent of a cross-section of women will see their implants fail in 10 years.

But in comments posted on Wednesday on the agency's Web site, reviewers wrote that implants, like cars and hearts, are more likely to fail as they age. Adjusting for the increasing risks that come with age, the agency estimated that 74 percent of a cross-section of women would suffer implant failures in 10 years. For women undergoing reconstructive surgery, mostly breast cancer survivors , the failure rate is 93 percent.

Saline implants fail, too, but such failures are quickly recognized by women as their breasts deflate. And there is little risk associated with saline seepage.

The risks of silicone seepage are not fully known, however. Scar tissue generally forms around most implants, but silicone leaks out of the scar pocket in about one-fourth of patients, the agency found. Because most failures of silicone implants go unrecognized, the agency suggested that women with them should undergo medical screening every year or two.

Dr. Mark Jewell, president elect of the American Society of Aesthetic Plastic Surgery, said he was surprised that the agency had estimated that silicone implants failed so often.

"That's certainly news and does need to be addressed," said Dr. Jewell, who has consulted for Inamed and Mentor. "But I feel that the devices should be approved."

The companies can track the safety of the devices after they are approved, he said. Women often find that silicone implants feel more natural than saline, Dr. Jewell said.

http://w ww. nytimes. com/2 005/04 /07/polit ics/07bre ast.h tml

and

http: //sur g erynews .net/ne ws/20 05/ 04/brea st04 05- 5.htm

By

http://www.the-dermatology-centre.co.uk/breastaugmentation.html

You are What you Eat - Supplements for Acne

Acne can seem like an invisible foe that shows up at the worst possible time, in the worst possible place. But don't despair! Smart skincare has a host of new treatments to help alleviate the appearance of acne, including dietary supplements!

Acne is a common skincare concern faced by many people, especially teenagers. And while many of us are quick to grab a cream or ointment in our haste to make bumps go away, there may be one other treatment for blemishes that you haven't tried: eating them away! It's no secret that taking a multi-vitamin on a daily basis is good for the entire body, but did you know that there are acne-specific vitamins and minerals that you can take to help clear the skin of blemishes, as well?

Before starting to take any skincare supplement, remember that supplements are just that: a supplement a healthy lifestyle. They are not miracle cures for acne and they need to be taken with care and caution. If you are taking any medications, consult with your doctor before starting to take any sort of dietary supplement. There are many dietary supplements that may help strengthen and protect the skin from the bacteria that cause acne, but a few of the most effective are: vitamins A, C, E, biotin, zinc and silicon. Not only can each of these supplements be taken individually to help with acne, they can also be combined for a synergistic affect.

The A-C-E Team

Vitamin A supports new cell growth and also helps regulate sebum production in the skin. Often seen as the enemy, sebum is a thin, watery substance that the body naturally produces to keep the skin moisturized and protected. However, some people have over-active sebum glands, which can result in too much sebum. When too much sebum is present on the skin, it can mix with dead skin cells, dirt and oil, creating a perfect breeding ground for blemishes or acne. To treat all the effects of blemishes, as well as prevent further outbreaks, try Murad Pure Skin Clarifying Supplement, a twice-per day oral supplement that contains Vitamin A, C and E, biotin and zinc for overall skin clarity and health.

Vitamin C (ascorbic acid), found in oranges, grapefruit, lemons and limes is another acne buster that is easy to add into the diet. Add sliced fruit to water or tea, squeeze the juices into ice cube trays before freezing, or simply eat the fruit to enjoy some of the many benefits of this hard-working vitamin. Ascorbic acid is required for tissue growth and healthy gums, aids in reducing levels of harmful cholesterol, and improves the texture and clarity of the skin by boosting collagen production, both when ingested and applied topically. In addition to eating Vitamin C, apply Vitamin C to the skin for a two-pronged attack against breakouts: MD Skin Care Alpha Beta Daily Face Peel is a two-step, thirty day peel kit for blemished skin which features Vitamin C and salicylic acid.

Vitamin E, another major anti-oxidant which helps combat acne, is also a super-potent scavenger of free radicals. In the body, Vitamin E protects cells from lipid oxidization and supports healthy cholesterol levels. Found in a large variety of foods, it's not hard to get this vitamin into the diet: avocadoes, corn, dark, leafy green vegetables, whole grains, eggs, sweet potatoes, oatmeal and many other foods contain Vitamin E. It also features prominently in most multi-vitamins: N.V. Perricone Physician's Super Antioxidant not only has potent doses of Vitamin E, but A and C, as well as biotin, zinc and dozens of other beneficial herbs and minerals.

Biotin, a B vitamin, is also necessary for healthy hair and skin, and aids in cell growth and fatty acid production. Found in cooked egg yolks, milk, poultry, saltwater fish and whole grains, this helpful vitamin is also produced by the intestines so an adult deficiency is rare. Many skincare companies are savvy to the benefits of this vitamin, as well, and it is popping up in skincare products and blemish treatments alike, such as: Pure Inventions Multi-Vitamin Plus and NeoStrata Oil Free Lotion - SPF 15.

Mineral Magic

Minerals are also important supplements to include in an acne-blasting skincare diet, especially zinc and silicon. An essential mineral, zinc is needed for protein synthesis and collagen production and it helps speed the healing of wounds and boosts the immune system. In addition, zinc may also help prevent acne when taken internally. Found naturally in egg yolks, fish, lima beans, mushrooms, whole grains, seafood, oysters, pecans and poultry, you can also apply it topically to help ease the appearance of blemishes. Murad Acne Spot Treatment combines zinc with sulphur, glycolic acid and salicylic acid to reduce redness and inflammation.

Silicon is also a defender of clear and glowing skin. Often seen in skincare products as silica, silicon is the one of the most abundant elements on the planet (second only to oxygen) and is needed for the formation of collagen, and to maintain healthy hair, skin and nails. It is also beneficial in the treatment off osteoporosis and in preventing cardiovascular disease. You can find silicon in beets, rolled oats, bell peppers, brown rice, leafy green vegetables and whole grains and it can also be found in skincare, as well. Murad Eye Treatment Complex SPF 8, Cellex-C Advanced C Skin Toning Mask and Philosophy Supernatural Air Brushed Canvas SPF all contain silica, as well as other anti-oxidants and vitamins to improve skin function and clarity.

Long Term Results

As with any new diet, results may take time so don't lose faith if you start taking supplements to help combat acne yet still continue to see spots for another few weeks. At least one month of consistent supplementation is the minimum you should give yourself to see results and happily, some will see a clearing of the acne much sooner. Boost your diet with skin-friendly foods and investigate supplements for a rock-solid foundation to beat the acne blues!

Re........:http: //ww w. skincar e-new s.c om /artic les.php?ArtI D=4 78