What not to say…to someone who has cancer

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It’s hard to know what to say when your friend or relative tells you they have cancer. In that painful moment our tact, good sense, knowledge and insight is put to the test – and so easily fails us.  As Joanna Moorhead of the Daily Mail recently wrote, the most inappropriate comments and messages have, at least, provided some laugh-out-loud moments after she was diagnosed with breast cancer. But with just a little effort, we really can do better. Here’s a guide to What Not To Say, and a few suggestions of better options. 1. Nothing at all. Not saying anything is fine if you have another way to be there for someone who’s hurting. Eye contact, a compassionate smile, a (welcome) gentle hug or hand squeeze, a small act of courtesy or kindness – all so important, and so much better than a verbal blatt. Actions really do speak louder (and often better) than words. Yet even the blattiest, dumbest remark (“My friend died of breast cancer”, “Not another one with cancer, it’s too much”, “Oh no, I can’t lose you”, “What bad luck!”) may be better than silent avoidance, which leaves the person feeling isolated and rejected.  People with cancer know it’s difficult for others -they’ve been through those emotions of shock too – but your absence is noted, and it hurts. It comes across as not caring, even though the truth is that you fear saying the wrong thing. Rather, go for simple sincerity: “I don’t know what to say, that’s terrible news” is absolutely fine. You don’t need sophistication: “That sucks, I’m so sorry” is also quite OK. After that, let your friend or family member’s response guide what happens next. You are part of her life for a reason, so just being yourself is all that’s needed. 2. Meaningless platitudes. If you woke up with stomach flu and spent a couple of days feeling utterly washed out and miserable, would you appreciate a walking, breathing Hallmark card suggesting that you count your blessings and be strong for your family? No, you would not. So why would dealing with a longer term but equally unpleasant illness be different? The fact that someone has cancer (or any other chronic illness) does not mean that he or she is unaware of the many wonderful blessings in life. Quite the reverse, in fact. Yet an ‘attitude of gratitude’ does not do away with pain and suffering, and “being strong” does not require an elaborate pretence that this doesn’t hurt. So dig deep and find a way to be there, alongside the suffering – be one of those blessings instead of talking about them. 3. False optimism. It’s good to get...

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Benign changes to the breast

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Unlike many other organs or tissues of the body, a woman’s breasts are shaped and defined by time. Before puberty, there’s nothing there at all. Then – exciting or intimidating as it may be – breasts begin to grow, taking a few years to reach their final shape and in the process becoming an important part of our body image. In human beings breasts are sexual organs, and it doesn’t take girls (or boys for that matter) long to discover that! Their exquisite sensitivity gives pleasure and their rounded shape helps define our womanly style – small and sporty, large and motherly, firm or soft. During pregnancy and after birth, breasts have a new lease on life as we discover their miraculous capacity to feed our babies as much and for as long as we need to. Though not all women are able to breastfeed, with the right help and support most can enjoy this simple, natural way to bond with and nurture our young. As breasts age, other changes take place which are completely normal – or at least common. Some are medically insignificant, such as the gradual change around the time of menopause from firm, dense glandular tissue to softer fatty tissue. Others tend to draw attention and cause anxiety because until investigated we cannot be sure that they are harmless. These are the benign conditions of the breast or “aberrations of normal development”. Lumps within breast tissue Lumps are common, occurring not only in aging breasts but also sometimes in younger breasts. A lump is a small piece of tissue or area under the skin that feels firmer than the surrounding tissue and can be felt from the outside. It doesn’t usually develop overnight and won’t be noticed until it reaches a certain size – at which point finding it can cause alarm and concern. Lumps that are medically concerning are those which stay there regardless of the menstrual cycle. Some women have naturally lumpy or uneven breasts and when the tissues swell under hormonal influence these “lumps” are more easily felt. For your own peace of mind, don’t hesitate to ask your doctor or nurse to check anything that worries you, but it’s the distinct lump which will require further investigation. Worrying as they are, many such lumps turn out to be “benign”. This means that although it is not normal breast tissue and may be growing larger, it does not spread or invade other tissues, either locally or by travelling through the lymph system (as cancer cells do). If you visit your doctor with a breast lump that worries you, he or he will ask you how long it has been there, whether you’ve...

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Birthday parties – 14 million of them

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Any excuse to celebrate, and millions of birthday parties around the world tell the story – cancer, though still a big public health concern, is not a death sentence. Since reaching a peak in the early 1990’s, cancer death rates have been steadily falling – at around 20% for women and over 25% for men. This is according to Cancer Research UK and the American Cancer Society. Probable reasons for this improvement are: – fewer people smoking – improved screening and early diagnosis for common cancers – more treatment options – targeted drug and/or radiotherapy treatment – new surgical techniques – more effective treatment and prevention of co-occurring conditions such as diabetes, obstructive airways disease, stomach ulcers, chronic infection and so on “We needed to give patients more options and better news about their future. I was impatient for more advances sooner and I still am. But clearly we’re moving in the right direction” – Prof Peter Johnson, Cancer Research UK There are still challenges. Pancreatic cancer appears to be on the rise, and amongst women, lung cancer has increasing by around 8% (whilst falling amongst men). This is thought to be the tragic harvest of 1960’s cigarette marketing, which successfully targeted millions of women by promoting tobacco smoking as an aid to slimming. Whilst older women tend to take better care of their health, younger women sometimes fail to notice or to report symptoms that could serve as early warnings of cancer. These include: – unexplained weight loss – bloating – breast changes: lumps, thickening, persisting rash, discharge, nipple changes – unusual bleeding – skin changes (moles, pigmentation, scaling) – difficulty swallowing – blood in urine or stool – gnawing abdominal pain especially associated with depression (may indicate pancreatic cancer) – indigestion for no apparent reason – white patches or spots in the mouth (especially if you are or were a smoker) – unexplained pain: not likely to be cancer but get it checked out – a swelling under the armpit, in the neck, or anywhere else – unexplained fever (sometimes associated with early blood cancers) – persistent fatigue, even if you think you have reasons to be so tired – persistent coughing There are a few ‘wild cards’ in our future whose effect on rates of cancer diagnosis and death are still unknown. The most worrying of these is the so-called “obesity epidemic”, especially insofar as it affects younger people. Recent research has connected excessive sugar consumption with a variety of conditions including auto-immune and inflammatory conditions which may predispose to some forms of cancer. We really need to start dealing with this!  ...

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Vitamin D – are you getting enough?

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For some time it’s been known that maintaining adequate levels of Vitamin D helps prevent cancer, especially colo-rectal cancer but also of the breast, pancreas and bladder. Now there’s evidence that women who already have breast cancer can benefit from increased Vitamin D. A major review study reported in the journal Anticancer Research has found that women with high levels of Vitamin D in their blood when diagnosed with breast cancer showed improved survival rates (at average 9 years), compared to women with low Vitamin D levels. The study involved 4443 patients with breast cancer and according to the statistics there is almost no probability that this difference occurred by chance – though further research is needed to see whether more severe illness can lower Vitamin D levels. Improved levels of Vitamin D prevent cancer by helping cells to stick together. When cells are loosely packed they start reproducing at a faster rate and may evolve into cancer cells. The presence of Vitamin D can keep a developing cancer in check by limiting its ability to develop its own blood supply, and/or to invade nearby structures like blood vessels. Dr Cedric Garland of the University of California, San Diego, told Medscape Medical News that up until a fairly late stage of development, cancer cells have intact Vitamin D receptors. He recommends that women undergoing treatment for breast cancer should check their blood levels of Vitamin D, to keep it in the optimal range. And most women could use more Vitamin D. The average American would be in the “low” group whereas the “high” group had nearly twice as much Vitamin D. Moreover, current recommendations for daily consumption are conservative: you would have to take a large amount of Vitamin D on a daily basis before signs of toxicity (such as thirst, nausea, stomach upset or muscle weakness) occur. This would be unlikely unless supplements are added to natural sources. Vitamin D deficiencies by contrast are fairly common, especially in climates where winters are long and cold. Some of the study data came from Canada, but studies in Southern Australia have also found Vitamin D deficiency, so South Africans shouldn’t be complacent about our sunny skies. Here are some ways to keep Vitamin D in good supply: – Sunlight. Make the most of the sun, especially in winter – it’s 100% free! You don’t need to risk getting burned – 20 minutes will do. After that, avoid the hottest part of the day or use sunblock, keeping the sun off your face if you want to protect your youthful good looks. – Oily fish, which comes with a bonus of cholesterol-free protein and heart-healthy fatty acids. A generous serving of...

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