as published in the october 2008 issue of indianapolis w ...as published in the october 2008 issue...

As published in the October 2008 issue of Indianapolis Woman magazine

K N O W Y O U R R I S K S 2 Breast, Cervical & Ovarian Cancers

When I think about cancers impacting women, I amreminded of three patients who came to see me inmy first month of practice in Appalachia years ago.

On my third day in practice, a woman and her husband cameto see me because her skin was breaking down on her left breast.On exam, she had a large, ulcerative breast cancer.Mammography and biopsy were not needed for the diagnosis ofthis end-stage disease.

During my second week of practice, a young woman came inwith the complaint of vaginal bleeding for almost a year. Onexam, her cervical cancer was quite obvious.

Two weeks later, another woman came to see me because she had bloating and constipationfor several months. Her examination revealed an ominous pelvic mass, and her ovariancancer was confirmed with further testing.

Cancer is serious, but denial and lack of awareness can turn a preventable or treatablecancer into a deadly one. A great deal of progress has been made in raising awarenessabout women’s cancers, improving early detection methods, increasing treatment options andsurvival rates and improving the quality of life for cancer patients and caregivers. But cancerstill claims too many Hoosier lives, so there is much more work to be done.

Leading a healthy lifestyle through proper nutrition, adequate physical activity, eliminatingtobacco and limiting alcohol consumption are basic steps all women need to take in order tohelp prevent many forms of cancer. Far too many women still do not get the recommendedscreenings for breast and cervical cancer and even more women are not aware of the symptomsthat could be a sign of ovarian cancer.

Unfortunately, screening and survival rates are even more dismal when you look at racialand ethnic minorities and groups with lower incomes and less access to quality health care.

In the following pages, you will find basic information all women need to have aboutbreast, cervical and ovarian cancer. You also will find resources that can provide additionalsupport and information, as well as personal stories that will compel you to take action.

As your state health commissioner and as a woman, I ask you to take an active role inreducing the devastation caused by cancer by completing the following tasks:

>> Thoroughly read this insert so you are informed about women’s cancers.>> Follow the recommended screening guidelines and know your risks.>> Pass this information along to your mother, daughter, friend, neighbor or co-worker and

encourage them to be proactive about cancer prevention and early detection.Cancer is a scary thing, but with knowledge comes power. I hope the information you gain

from the next few pages will empower you to take action. It could save your life or the life ofa woman you love.

Judy Monroe, M.D.State Health Commissioner

Cancer is a Scary ThingBut with knowledge comes power

Table of ContentsLetter from Dr. Judy Monroe 2

Women and Cancer 3

Test Your Knowledge Quiz 3

Health Disparities 4

Cancer Glossary 4

Your Questions Answered 5-6

Supporting Those You Love 6-7

By The Numbers 7

Cervical Cancer Facts 8

There is Help 8-9

HPV and Cervical Cancer 9

Overcoming Ovarian Cancer 10

Ovarian Cancer 10

Know Your Risks 11

Q&A 11

Just for Caregivers 12

Surviving for the Long Term 12-13

Quality of Life 13

Cancer Clinical Trials 14

Indiana Cancer Consortium 14

Quiz Answers 15

Indiana Joint Council for Women’s Cancers 15

Resources 16

Thank You to Our Sponsors 16


Unfortunately, the cure for cancer isstill unknown and some cancerdeaths are not preventable.

However, the good news is that engaging ina healthy lifestyle is proven to dramaticallyreduce your cancer risk.

For the majority of women who do notsmoke, dietary choices and physical activity arethe most important modifiable determinantsof cancer risk. According to the AmericanCancer Society, one-third of cancer deaths inthe United States can be attributed to dietand physical activity habits, with anotherthird due to smoking.

Although genetics influence the risk ofcancer and cancer develops from geneticmutations in cells, most variation in cancerrisk is due to factors that are not inherited.Behavioral factors, such as abstaining fromtobacco, consuming a diet rich in nutritious

foods and staying active across the lifespan,can substantially reduce a woman’s risk ofdeveloping cancer.

All women should follow the AmericanCancer Society’s nutrition and physical activityguidelines for reducing cancer risk:

> Maintain a healthy weight throughoutlife. Balance caloric intake with physicalactivity. Avoid excessive weight gain. Try tolose weight if you are considered overweightor obese.

> Adopt a physically active lifestyle.Engage in moderate to vigorous activity for30 minutes or more, in addition to usualactivities, at least five days a week; 45 to 60minutes of intentional activity are preferable.

> Consume a healthy diet. Eat a variety offive or more servings of fruits and vegetablesper day. Choose whole grains over processedgrains or sugars. Limit red meat consumption.

> Limit alcoholicbeverages to one per day.

If you are not leading a healthy lifestyle,commit to making one change at a time. Startby taking the Great American Health CheckChallenge at www.cancer.org/greatamericans.This four-step survey assesses your currenthealth status by asking questions regardingpersonal characteristics, eating habits,physical activity, and alcohol and tobacco.Upon completion of the Great AmericanHealth Check Challenge, you will receive apersonalized action plan to share with yourphysician.

The American Cancer Society providesvarious resources related to nutrition andphysical activity, cancer risk reduction, andoverall health benefits. For more information,please log on www.cancer.org or call (800) ACS-2345.

Test Your Knowledgeby Tanya Parrish, MPH, C.H.E.S., Director of the Office of Women’s Health, Indiana StateDepartment of Health

(Answers on Page 15)Cancer is a scary subject for all of us. But the more we know about cancer, its causes, risk factors and early

detection methods, the better prepared we will be to tackle it head on. Find out how much you already knowabout breast, cervical and ovarian cancer by taking the quiz below. Then read the following pages to make sureyou have the facts you need to protect and care for yourself as well as the women you love.

11.. There are no signs or symptoms of ovarian cancer. True False22.. Breast cancer is the No. 1 killer of Hoosier women. True False33.. The HPV vaccine is most effective when given before a female becomes sexually active. True False44.. A Pap smear does not screen for ovarian cancer. True False55.. African-American women are more likely to survive breast cancer than white women. True False66.. Women who have had breast cancer are at increased risk of ovarian cancer. True False77.. Cervical cancer can be prevented. True False88.. A woman’s risk for breast cancer decreases as she gets older. True False99.. One out of four people in the United States between the ages of 15 to 24 is infected with HPV. True False

1100.. Smoking can increase your risk of cervical cancer. True False

Women and CancerThe good, the bad and the choice to live a healthier life

by Keylee M. Wright, Director, Indiana Comprehensive Cancer Control Program, American Cancer Society in partnership with the Indiana State Department of Health

Keylee M. Wright

Tanya Parrish


As the President and CEO of theIndiana Minority Health Coalition, Iam greatly concerned by the impact of

breast, cervical and ovarian cancer and amcommitted to addressing the disparities thatexist in communities of color. Cancer continuesto touch the lives of countless Americans anddoes so disproportionately among minority groups.

Numerous health disparities exist amongminority women, particularly in the screening, diagnosis and survivalrates and can be attributed to multiple factors. Indicators pointto social and economic inequities in which poverty is the mostimportant factor.

Members of racial and ethnic minorities tend to be poorer and lackhealth insurance coverage. In fact, 24 percent of African Americansand 22 percent of Hispanic/Latinos live below the poverty line,compared with 8 percent of Whites. This is important, consideringpoor and uninsured people are more likely to be treated for cancer atlate stages of disease and are more likely to die from cancer.

Research indicates that cultural and genetic factors influencecancer risks. For example, women from cultures where early marriageis encouraged, have a lower risk of breast cancer because they are likelyto have children at an earlier age. Even with the lower incidence rateof breast cancer, African-American and Hispanic women are morelikely to die from breast cancer compared to white women.

With cervical cancer, Pap screening rates are lower amongminority women. African-American women are diagnosed withcervical cancer at higher rates than white women and are morelikely to be diagnosed with a later stage of cervical cancer. Hispanicwomen are twice as likely to develop cervical cancer compared tonon-Hispanic women. Asian-American women are 1.2 times morelikely to have cervical cancer compared to white women.

Among minority women, American Indians and Hispanics arediagnosed with ovarian cancer at higher rates than African Americansand Asian Americans. However, American Indians and African-Americanwomen die from ovarian cancer more than Hispanic and Asian-American women.

We have known for some time that early screening and detectionare key to reducing premature death from this dreaded disease. Weremain constantly challenged to find ways to get the word out,encourage community members to take action, and remove barriersthat contribute to health disparities in Indiana.

Nancy JewellPresident and CEO

Health Disparities Obstacles contribute to breast, cervical andovarian cancer among minority women

Cancer Glossary Learn basic terms to get a handle on dealing witha complex disease

Cancer is the second leading cause of death for women in Indiana,so fear and confusion are natural responses to a cancer diagnosis.Though you can’t change your diagnosis, being well informed canhelp minimize your anxiety and stress.

Here are some commonly used terms to assist you in understandingthe information on the following pages:

Benign –– Not cancerous. Biopsy –– Removal of cells or tissues or examination by a pathologist. CA-125 –– Substance sometimes found in an increased amount in

the blood, other body fluids or tissues. Increased levels of CA-125 maysuggest the presence of some types of cancer.

Chemotherapy –– Treatment with drugs that kill cancer cells.Clinical trial –– Type of research study using volunteers to test new

methods of screening, prevention, diagnosis or treatment of disease. Cyst –– Sac or capsule in the body. It may be filled with fluid or

other material.Lumpectomy –– Surgery to remove the tumor and a small

amount of normal tissue around it. Lymphedema –– Condition in which excess fluid collects in

tissue and causes swelling.Malignant –– Cancerous. Mammogram –– X-ray of the breast.Mastectomy –– Surgery used to remove the breast.Oncologist –– Doctor who specializes in diagnosing and

treating cancer.Metastis –– Spread of cancer from one part of the body to another. Precancerous –– Term used to describe a condition that may

become cancer. Quality of life –– Overall enjoyment of life. Remission –– A period of time when the cancer is responding to

treatment or is under control.Risk factor –– Something that may increase the chance of

developing a disease. Screening –– Checking for disease when there are no symptoms.Tumor –– Abnormal mass of tissue that results when cells divide

more than they should or do not die when they should. Tumors maybe benign or malignant.

Ultrasound –– A procedure in which high-energy sound wavesare bounced off internal tissues or organs and make echoes. The echopatterns are shown on the screen of an ultrasound machine, forminga picture of body tissues called a sonogram.

Nancy Jewell


Q: How many women are diagnosedwith breast cancer each year?

A: According to the American CancerSociety, breast cancer leads the list at 26percent of all newly diagnosed cancers inwomen. In real numbers, 182,460 newbreast cancer cases were diagnosed in 2007,about 1 percent or 1,990 of which occurredin men. Last year, 3,660 new breast cancercases were identified in Indiana.

Q: Who has the highest risk ofdeveloping cancer?

A: Statistically speaking, if you are awhite woman living in the United States youhave the highest incidence of breast cancer inthe world. The risk of developing breastcancer increases with age, reaching a peakaround the mid-seventh decade of life.Although the incidence is substantially lowerin younger women, even women in their 20sand early 30s develop breast cancer.

Q: What are the risk factors fordeveloping breast cancer?

A: In my patient discussions, I dividebreast cancer risk factors into three majorcategories — familial risks, estrogen exposureand environmental exposure. A person’s familyhistory weighs heavily in breast cancer riskassessment.

The number of first-degree relativeswith breast, ovarian or uterine cancer issignificant. This is particularly important ifthat relative was premenopausal at the time ofthe diagnosis, if two or more of these tumorsoccurred in the same patient, if the diseaseaffected both breasts or if the relative withbreast cancer was a male.

The exposure to estrogen has been shownto increase the risk of breast cancer. Thereforewomen who start their menses below theage of 12 or who continue to have periodsafter age 50 are at increased risk. If a womannever carries a full-term pregnancy or ifshe delays her first full-term pregnancy untillater in life her risk is increased. Womenwho take hormone replacement therapycombining estrogen and progesterone are

Your Questions AnsweredAn interview with Robert J. Goulet Jr., M.D., Professor of Surgery, Director of

Breast Surgical Oncology, Indiana University Melvin and Bren Simon Cancer Center

at increased risk.Environmental risk factors cover a wide

range of exposures. Previous medical therapy,such as radiation therapy for a childhoodmalignancy, may increase the subsequentrisk of breast cancer. Exposure to carcinogensin the workplace may also play a significantrole. Cigarette smoke, both primary andsecondhand, increases a woman’s risk.Certain dietary factors like high concentratedfats and excessive alcohol intake have alsobeen implicated in breast cancer risk.

Q: What are the warning signs andsymptoms a person should look for?

A: Despite the fact that the AmericanCancer Society and National Breast CancerCoalition have withdrawn their supportfor monthly breast self-exam, I continueto encourage my patients to becomefamiliar with their bodies by observingtheir breasts and conducting self-exams (seebox). Nipple discharge can be disconcerting.Many women will have some element ofnipple discharge and, in most cases, it isharmless. If the discharge occurs spontaneouslyor appears bloody, further evaluation isnecessary.

The most ominous changes of the breastare associated with inflammatory breast cancer. The breast undergoes a rapid increasein size (usually over a week to 10 days). Thepatient complains that the breast feelsheavier and her bra no longer fits properly.There is swelling of the skin, which ismarked by small pitting across the surfaceof the breast and there is a distinct rednesswhich progresses. Although patients complainof discomfort to the area, the pain is nottypically intense. There is no associatedtemperature elevation or shaking chillstypically seen in the context of a breastabscess. Any change that lasts for more than30 days, should be brought to the attentionof a health care professional.

Q: What is the best way of ensuringearly detection?

A: Early detection is the key to success in

treating breast cancer. For women with nospecial risk factors, the American CancerSociety recommends annual clinicalexamination by your health care providerbeginning in early adulthood and annualmammogram beginning at age 40.

For women with a first-degree relativewith a history of breast cancer, the screeningshould begin 10 years before the onset ofthe relative’s disease.

If your mother was diagnosed withbreast cancer at age 40, you should beginyour annual screening mammograms atage 30. There is ample data that supportsthe use of screening MRI in women whoare at high risk and have dense breast tissuenoted on mammography.

If an abnormality is detected on screening,then diagnostic studies should follow andif necessary, a biopsy of the breast tissueshould be performed.

Q: What about prevention?A: In breast cancer prevention, the first

step is to clearly identify one’s risk status.In some cases, genetic testing is performedthat can identify an inherited abnormalitythat significantly increases the danger ofbreast cancer.

Breast cancer prevention has been areality since 1998 when researchers, evaluatinga group of women facing increased threatof breast cancer due to a variety of factors,reduced the risk of developing a malignancyby 50 percent overall with the prophylacticadministration of a drug, tamoxifen, forfive years. Since then, other medicationshave been tested and found effective inrisk reduction and new medications arecurrently being evaluated in their role aspreventative agents.

In some cases, particularly in women withdocumented genetic defects, prophylactic sur-gery may be recommended, which mayinclude removal of the ovaries and fallopiantubes, in addition to mastectomies. Althoughsurgical intervention results in dramatic riskreduction, it does not eliminate the possibilityof breast or ovarian cancer and FFF

Robert J. Goulet Jr., M.D.


“Sisters, sisters, there were neversuch devoted sisters.” So goes thesong from the classic film White

Christmas. Annette Gross shares this sentiment with

her identical twin, Marlene Rosol. More thanjust sisters, these two friends talk more thanonce a day. Their chats are filled with everydaythings like “Guess what happened?” or “Letme tell you about this great dress I bought.”

So when Marlene called Annette on Sept.29, 2005, she didn’t think it was a call aboutanything out of the ordinary. But Marlenesounded nervous. Out tumbled the story ofhow doctors found what appeared to be a spoton her breast during a routine mammogram.

Annette’s immediate response was disbeliefand then concern. “Suddenly, there’s just thisbig question mark on your life,” she says.“You have to take each day as it comes afterhearing that kind of news.”

Annette thought about the implications ofher sister’s news. “As I listened, I was shocked.I knew other people who had breast cancer.

Supporting Those You LoveAnnette Gross, twin sister of a breast cancer

survivor, makes a differenceby Deb Wezensky

Our (paternal) grandmothersurvived it at the age of 72.But this was someoneespecially close to me: my identical twinsister. It was kind of scary to see what shewould have to go through. I also thought thatmight raise the chances for me,” she says.

Already thinking about her full-time joband how it might be affected by the potentialof having breast cancer, Marlene’s futuresuddenly seemed uncertain.

A second mammogram quickly wasperformed, confirming the presence of alump. A biopsy was performed on Oct. 7.Diagnosis: malignant.

On Oct. 18, Marlene had the lumpremoved, along with 12 lymph nodes. Justafter Thanksgiving, she started 36 sessions ofradiation.

Marlene was told that her cancer wasestrogen based. She had taken estrogen aftera hysterectomy in 1992, and that may haveexacerbated her cancer.

Annette wanted to be there to support

Marlene’s PrognosisFor three years, Annette Gross’ sister Marlene has gone to routine checkups and has

a clean bill of health. Having breast cancer did change her outlook on life. She’s morepositive than ever. Marlene says, “Since I survived breast cancer, I can do anything.”

When other health issues come up, she says, “Well, I’ve gone through breast cancer,so I can deal with this.”

Marlene’s attitude has affected Annette as well. Seeing her sister deal with breast cancerhelps her keep things in perspective too. “I have learned what’s really important: family,”Annette says. “I treasure my family; we are very, very close.”

continued surveillance is necessary.

Q: What lifestyle changes will helpreduce the risks for developing breastcancer?

A: Obesity, particularly post-menopausal,increases the hazard of breast cancer. Theconsumption of a diet high in saturated fatsis related to this.

Excessive alcohol consumption alsoincreases a woman’s risk of breast cancer.Exercise, for as little as 30 minutes threetimes a week, results in breast cancer riskreduction.

If you smoke, stop! Women who smokehave an increased risk of a variety of associatedhealth problems, including breast cancer.If you have adopted risky behaviors (i.e.;smoking, overeating), deal with them nowand seek professional help if necessary.

Performing a Self-ExamStep 1: LookA woman should stand in front of a

mirror with her hands at her sides andlook at her breasts from the front andthen side to side.

She should focus on changes in thesize, shape and symmetry of the breasts.Look at the contour of the nipples andskin for changes in color, swelling orretraction. This should be repeated withthe arms raised above the head. Thismaneuver may accentuate more subtlechanges.

Step 2: Feel Next, palpate the breasts. This can be

done standing up or while lying down.Use gentle pressure to each area of thebreast starting with a light touch, thenmoderate touch, and then deep touch.Normal breast tissue is compressible, whileabnormal tissue will hold its shape underthis pressure. You cannot differentiatebetween a cyst and a solid mass of thebreast on palpation.

— Robert J. Goulet Jr., MD, Professor ofSurgery, Director of Breast Surgical Oncology,Indiana University Simon Cancer Center


Marlene as she dealt with her breast cancertreatments. But because of her own healthconcerns with fibromyalgia, she was unableto travel to North Carolina to be at her side.She also cared for their mother who grievedthe loss of her husband of 62 years as well asdealing with lung cancer.

But what she could do was keep a sense ofnormalcy for her sister. They continued to talkmany times, every day. “My mom and I wereable to support Marlene by just talking withher … not necessarily about her breast cancer,but just to be there for her,” Annette says.

A short time later, Annette found somethingelse she could do. While reading a BreastCancer Network of Strength™ (formerlyY-Me) newsletter, she found a way to supportMarlene and other women affected by breastcancer.

The words “sister study” jumped right out ather. Since Annette struggles with fibromyalgiasymptoms, she couldn’t participate in theSusan G. Komen walks. But when she sawthis invitation to participate in a study forsisters of women affected by breast cancer,she thought, This is something I can do — ifthey’ll have me.

Excited about her chance to make a differ-ence, Annette inquired about being a part ofthe study. The Sister Study researches geneticand environmental factors related to breastcancer in a diverse group of 50,000 unaffectedwomen whose sisters had been affected bybreast cancer. “My sister and I couldn’t havebeen raised any closer,” Annette says. “As veryyoung children, we slept in the same bed. I’llbe perfect for this study.”

An initial questionnaire was sent toAnnette to determine whether she qualifiedfor participation. Based on her responses, shebecame a part of the 10-year study.

The study involved a number of steps.Annette had to sign a consent form. She then

answered questions about the food she ate,the amounts she ate and when. She had tosend in toenail clippings and dust collectedfrom her house. Two telephone interviewswere then conducted about the environmentsin which she had lived. There were questionsabout the presence of animals nearby andusing nail polish, deodorant and hairspray. Anurse came to her house and conducted ahealth evaluation, including weight, heightand body fat measurement, as well as collectingblood and urine samples.

Since completing the first part of thestudy, Annette received a summary of theresults of her health evaluation, along withsuggestions on how to improve her health.But the real benefit is knowing that she ishelping reduce the number of womenaffected by breast cancer.

“I feel like not only am I helping my sister,but I’m helping other people. Even thoughprognoses are better, breast cancer has got tobe one of the scariest things for a woman togo through. Anything that we can do iswonderful.”

Her advice?“Go for your routine mammogram. It’s

not invasive. It can save your life.”

Participants NeededThe Sister Study is the only long-term

study of women ages 35 to 74 whosesister had breast cancer. It is a nationalstudy to learn how environment andgenes affect the chances of getting breastcancer. A total of 50,000 women willjoin the effort to find the causes ofbreast cancer.

There has been a great response to thestudy. However, more women fromspecific groups still are needed to ensurethe study represents all women. Therefore,until the end of 2008, or when thenumber of desired participants is met,the study is only enrolling women fromgroups that are underrepresented in thestudy to date:

African Americans, Latinas, Asians andPacific Islanders, and Native Americansages 35 to 74.

Caucasian women ages 65 to 74 orwith a high school degree or less.

For more information, call (877) 474-7837 or log on www.sisterstudy.org.

By the NumbersHealthy Habits

>> Only 43.7 percent of women inIndiana met the recommendations forphysical activity in 2007.

>> 74.3 percent of Hoosier womenconsume less than five servings of fruitsand vegetables a day in 2007.

>> 22.5 percent of women in Indiana arecurrent smokers, based on 2007 statistics.

Early Detection in Indiana>> Of women age 40 and older, 71.6

percent had a mammogram in the pasttwo years, according to 2006 figures.

>> Of women age 18 and older, 81percent had a Pap test in the past threeyears, according to 2006 statistics.

New CancersAccording to 2005 data, the most

recent available, the following numbers ofnew cancer cases were identified in Indianawomen:

Breast: 3,800Cervical: 232Ovarian: 401

Cancer DeathsAccording to 2005 data, the most

recent available, the following numbers ofHoosier women died from cancer:

Breast: 827Cervical: 87Ovarian: 341

* Source: 2006 and 2007 Indiana BRFSS and

Indiana State Cancer Registry

As a child, Annette Gross (above left), sharesGrandma Stella's lap with twin Marlene Rosol.

Annette (far left) continues to maintain a closerelationship with her sister, Marlene (right).


All women are at risk for cervical cancer.It occurs most often in women ages30 and older. In 2004, the most

recent year for which statistics are available,11,892 women in the United States weretold they had cervical cancer, and 3,850 diedfrom the disease, according to the U.S.Cancer Statistics Working Group.*

Largely due to Pap test screening, thedeath rate from cervical cancer has decreasedgreatly. It is important to get tested forcervical cancer because six of 10 cervicalcancers occur in women who have neverreceived a Pap test or have not been tested inthe past five years.

Two methods of testing for cervical cancerare currently available. One is the traditionalPap test in which surface cells are collectedfrom the cervix, or opening of the uterus, andtransferred to a glass slide. The other is theliquid-based method in which a swab transferscells from the cervix to a tube containingliquid that preserves the specimen.

Both tests can be performed in the doctor’soffice during a woman’s annual gynecologicalexam. After three consecutive negativescreening tests, most physicians recommendcervical cancer screening every two to threeyears. However, a woman’s age and otherfactors can affect this. Women should consultwith their physicians to determine whichscreening interval is appropriate for them.

It is not uncommonfor women to have anabnormal cervical cancerscreening test at somepoint in their lives.These results are usuallyprecancerous, and it is upto a woman and herprovider to decide whether or not treatment isneeded. Often, a repeat screening test in threeto six months is all that is required.

The human papillomavirus is a commonvirus that can be passed from one person toanother during sex and is the main cause ofcervical cancer. There are many differentstrains of HPV, and not all cause cervicalcancer. Women can be tested for HPV fromthe same specimen used for their cervicalcancer screening test. At least half of sexuallyactive people will have HPV at some point intheir lives, but few women will get cervicalcancer as a result of the infection.

It is important to remember that cervicalcancer can be prevented if abnormal cells arefound and treated as recommended. Evenwith a diagnosis of cervical cancer, if thecancer is found in an early stage, successfultreatment is available.

The best protection is early detection, soall women should talk to their health careprovider about getting screened for cervicalcancer.

There is HelpComing back from the “edge,”Wanda Cook finds the supportshe needsby Keylee M. Wright, Director, IndianaComprehensive Cancer ControlProgram, American Cancer Society inpartnership with the Indiana StateDepartment of Health

Wanda Cook, a 55-year-old mother offour and grandmother to 13, experiencedsevere stomach pain months prior to hercervical cancer diagnosis in April.

After work one evening, Cook doubledover with excruciating pain. Her husbandrushed her to a local hospital, where sheinitially was treated for ear, urinary tractand sinus infections.

“It had been 20 years since I’d beenchecked by a doctor,” Cook says. “I keptthinking cancer but put it in the back ofmy mind.”

Cook attempted to return to workafter her hospitalization but hadn’texperienced any relief and couldn’t standthe pain any longer.

She visited Wishard Health Services inIndianapolis, and along with her family,received the bad news. Not only did shehave cervical cancer, it was too advancedto operate.

“Just the word ‘cancer’ is enough todrive you over the edge,” Cook says.

Cook began chemotherapy andradiation immediately. Her treatmentrequired she and her husband travelabout 120 miles roundtrip, five days aweek. Her family has supported herthroughout her illness.

“They try to stay positive, but they arereally concerned and worried about me,”Cook says. “My kids have been helpingpay for gas.”

With no income, finances have been

Cervical Cancer FactsDon’t delay: Screening, early detection and

diagnosis keep you saferby Cathey Carter, R.N., Indiana Breast & Cervical Cancer

Program Case Manager

* U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2004 Incidence and Mortality. Atlanta(GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and NationalCancer Institute; 2007.

Cathey Carter

Wanda Cook, seated left


a major concern. Cook has receivedassistance from EMBRACE, a programthat offers wraparound services to womenreceiving cancer treatment at WishardHealth Services (see more about theEMBRACE program on page 12).EMBRACE provided a gift card to helppay for groceries and some much neededguidance to identify other communityresources.

“We’re still waiting to hear from SSI,”Cook says. “I called another organizationfor help, but they were out of funds.”

Beyond finances, Cook has struggledwith depression. She’s worried abouther next doctor’s appointment. Thecancer is in her lymph nodes, and she stillexperiences pain.

Cook admits though her experiencehas been extremely difficult, she haslearned a lot from her battle with cancer.She still has a lot of life left in her and alot to live for.

Her advice to other women: “Yourhealth is more important than anything.You need to be checked regularly by adoctor. There’s help out there. If youdon’t have insurance or whatever, you justhave to find it.”

Physicians long have suspected arelationship between sexual activityand cervical cancer, but it wasn’t until

the 1980s that scientists were able to provethis link by isolating the genetic material fromhuman wart, or papilloma, virus in cervicalcancer cells. To date, more than 100 types ofhuman papilloma virus, or HPV, have beenidentified, and about 40 of these are capableof infecting the human genital tract.

Low-risk HPV types, such as 6 and 11,are responsible for causing genital warts orbenign cervical cell abnormalities. It is thehigh-risk virus types, including 16 and 18,that have the potential to cause changes incervical cells leading to cancer if left untreated.High-risk HPV types are detected in 99percent of cervical cancers. Types 16 and 18alone are responsible for about 70 percent ofcervical and anogenital cancers worldwide.

The Centers for Disease Control andPrevention estimate about 20 millionAmericans are infected with at least one typeof HPV. A study done by Eileen Dunne at theCDC found more than one out of every fourwomen between the ages of 14 and 59 wereinfected with HPV. That number increases toone out of every three young women ages 15to 19 and almost one out of every two women20 to 24 years of age, according to the 2007article “Prevalence of HPV Infection AmongFemales in the United States,” Journal of theAmerican Medical Association.

Many of these infections are asymptomatic,and 90 percent will resolve spontaneously

HPV and Cervical CancerPersistent HPV infections are linked to cervical cancer

by Joan Duwve, M.D., M.P.H., Medical Director, Human Health Services andPreparedness Commission, Indiana State Department of Health

over time. Infections thatpersist may cause genitalwarts, abnormal Papsmears or cervical cancer.The risk of becominginfected with HPVincreases with the numberof sexual partners;however, 49 percent ofthe women in a recent study (none of whomhad been sexually active before) were infectedwith HPV after being in a monogamousrelationship for three years. The only factorassociated with the risk of HPV infection inthese women was the number of previouspartners of their male partner, according toThe Journal of Infectious Disease.

Fortunately, there is now a safe andeffective vaccine for women between theages of 9 and 26 against four types ofHPV. The HPV vaccine is a series of threeshots, given over a six-month period. Becausethe vaccine prevents most HPV infectionsbut does not treat existing infections, itworks better when given prior to initiationof sexual activity.

In the 2007 Indiana Youth Risk BehaviorSurvey of high school students across Indiana,it was found that half of ninth- through12th-graders had already had sex. The CDCrecommends routine vaccination of girls atthe age of 11 or 12 and vaccination of womenages 13 to 26 not previously vaccinated.

For more information, talk to your doctoror log on www.cdc.gov.

Did You Know?Publicly funded schools in Indiana

are required by law to inform parents ofall sixth-grade girls about HPV and theHPV vaccine.

As of 2008, the law requires publiclyfunded schools to ask parents whetherthey have vaccinated or plan to vaccinatetheir daughters.

The data collected is anonymous andcannot be used to identify parents orgirls or to prevent school entry.

Joan Duwve, M.D.


Painkillers and antacids were alwayswithin Pat Gray’s reach to placate thepain and bloating she experienced in

early 2003. She was part of a team imple-menting new billing software in her company,so she attributed the symptoms to stress.

That summer, it dawned on her thatsomething wasn’t right. The next day, she madean appointment to see her doctor.

Given her symptoms, a colonostemy wasordered, but the attending gastroenterologistsaw nothing notable. Gray was told she mostlikely suffered from an irritable bowel.

She watched her diet more closely anddecided to “hang in there.” Gray endured along winter of fatigue and constant abdominaldiscomfort. Then, as if with a breath of freshspring air, she experienced relief from hersymptoms that lasted until midsummer.

But it was a short reprieve. Her symptomsreturned with a vengeance. She relented,“Enough; there must be something to be doneto give me relief.” Given the severity of hersymptoms, Gray saw her doctor who wasgreatly concerned and scheduled her for anultrasound and other tests within the hour.

His concern was not unfounded. Thenext morning, Gray received a call telling ofher diagnosis: She had ovarian cancer. Shelistened vaguely as she was told appointmentswith an oncologist and surgeon were beingmade. “I was stunned –– my family healthhistory involved heart disease –– not cancer.I knew nothing of cancer treatment andresponse other than general information thatwe’re all exposed to.”

Within the next few days, she was under thecare of a “wonderful” team of an oncologist andgynecological oncologist. Her oncologistconfirmed her diagnosis of ovarian cancer IIIC.The cancer had spread to the membrane liningof her abdominal cavity, diaphragm and outercasing of her intestine and possibly could havespread to lymph nodes in the abdomen.Together, they discussed her treatment, and inGray’s mind, her complete recovery.

At first, she was reluctant to discuss being ill.“Perhaps I’m a more private person than Ithought,” Gray says. “But I think it was more

Overcoming Ovarian CancerPat Gray learns to stay true to what her body tells her

by Deb Wezensky

about my wrappingmy mind around thewhole thing.”

As a single woman,Gray worried abouther daughter and son.“I needed to be strongand show them we would endure this,” she says.

Treatment began immediately when fiveliters of cancerous fluid were drained from herabdomen, a huge relief from extreme bloating.

Chemotherapy was started to reduce thesize of her tumors before her upcomingsurgery and resumed after the procedure.

When she began to lose her hair, Graybought a razor and asked her son andgrandchildren to shave her head. “It turned outto be a good way to involve my grandchildrenin understanding I was ill,” Gray shares.

Her co-workers were very supportive. ButGray’s greatest support was her family. Herchildren accompanied her to doctors’appointments. Her daughter came, taking timeoff from work, to care for her after surgery.

Fortunately, cancer was not found in Gray’svital organs or her lymph system. Any activecells still present were removed with a completehysterectomy and removal of her appendix, gallbladder and the fatty panel of her abdomen.

Surviving an advanced cancer, Grayfeels it is essential to educate other womenabout ovarian cancer. She worked as atemporary office manager at Ovar’comingTogether, an Indianapolis-based not-for-profit organization dedicated to raiseawareness of ovarian cancer. She alsoserves on its board of directors.

Realizing she was at high risk for recurrencefor the first few years, Gray made the most ofher days. She took her oldest grandson on asafari in Tanzania, a dream of hers since readingher grandfather’s book on travel in Africa.

True to her sense of mission, Gray hasthese words of wisdom to share with others:“Women must claim responsibility for thecare of their bodies regardless of medicalresponse ... Doctors aid us; but it’s ourpersistence (toward) our own personal goodhealth that will ensure our wellness.”

Pat Gray

Ovarian CancerRemaining silent about certainchanges in your body can be lifethreateningby Deb Wezensky

Though ovarian cancer is rare, detecting itat an early stage is challenging. Only 19 percentof all ovarian cancers are found before theyspread outside the ovary.

Once ovarian cancer has been foundoutside the ovary, the five-year survival rateis only 45 percent, according to the AmericanCancer Society. Awareness and early detectionare critical to improved outcomes.

Symptoms are very subtle, persistent andincrease over time. The warning signs can beeasily misunderstood as symptoms of otherhealth concerns. Women must know theirbodies and pay attention when they experiencedifferences in how they function. It is helpfulto keep a record of the differences you observeto discuss with your physician.

In June 2007, a National ConsensusStatement identified these symptoms forovarian cancer:

> pelvic or abdominal pain> bloating> urinary problems, including urgency

or frequency> indigestion or a feeling of fullness

after a light mealMany women tend to seek the care of a

gastroenterologist when first suffering fromovarian cancer because the symptoms aresimilar to those of bowel or urinary illnesses. Ifthese symptoms persist and are different fromyour normal body, don’t delay. Discuss yourconcerns with your health care provider.

Tests for early detection ofovarian cancer include:

> A rectal pelvic exam along with a trans-vaginal ultrasound

> A CA-125 blood test. If tests reveal amass in the ovaries and a CA-125 has risenabove 30, seek a referral to a gynecologiconcologist for further evaluation.

If the exam and tests are normal, it isreasonable to wait two to three weeks. Ifsymptoms do not resolve themselves, makean appointment with your doctor to discussthe possibility of undergoing additionalstudies, like an MRI or CT scan.


Know Your Risks Ovarian cancer: Less “common” butdeadliest of the cancers affectingwomenby Deb Wezensky

About 600 Hoosier women were diagnosedwith ovarian cancer in 2007. Though ovariancancer is not a “common” cancer, each womanhas a one in 70 lifetime risk of developing it.The symptoms for ovarian cancer are vague,and the survival rate has had almost noimprovement in 30 years because it usually isfound in advanced stages. It is important tounderstand your risk, but there are severalfactors to consider:

GeneticsA significant risk factor is an inherited

genetic mutation in the BRCA1 or BRCA2genes, according to the Ovarian CancerNational Alliance.

Increasing ageRisk increases with age. About 68 percent

of women diagnosed are age 55 or older.

Reproductive historyTalk to your health care provider about the

relationship between the number of menstrualcycles in a woman’s lifetime and her risk ofdeveloping ovarian cancer.

ObesityRecent studies suggest obesity in early

adulthood is associated with an increasedrisk up to 50 percent of ovarian cancer.

Understanding your risk for developingovarian cancer is important, but be awarethat the majority of women who get ovariancancer do not have obvious risk factors. It’simportant to pay attention to signs thatsomething might not be right. Women needto work with their health care provider todetermine the cause and the best course ofaction.

Q: Nationally, how many womenare diagnosed with ovarian cancereach year?

A: According to estimates by theAmerican Cancer Society, in 2008 there willbe 21,650 new cases of ovarian cancer in theUnited States. The lifetime risk for a womanto develop ovarian cancer is one out of every70 women.

Q: Are there specific populations ofwomen at risk for developing ovariancancer?

A: There are a number of factors that mayslightly increase the likelihood for a womanto develop ovarian cancer including:

11)) reproductive factors such as infertility(or never having become pregnant);

22)) processes leading to pelvic inflamma-tion such as pelvic infections orendometriosis;

33)) demographic factors such as NorthAmerican or Western European residency;

44)) dietary factors such as higher consump-tion of lactose (dairy products such as cottagecheese or yogurt) or fatty foods; and

55)) hormonal factors such as the use ofpostmenopausal hormone replacement;conversely, the use of birth control pillsdecreases ovarian cancer risk. Much morecritical is the risk associated with a familyhistory of multiple relatives with breastand/or ovarian cancer. Individuals with sucha family history, or who have a known mutationin the BRCA1 or BRCA2 genes, have a 15percent to 44 percent lifetime risk fordeveloping ovarian cancer.

Q: Describe the various stages ofovarian cancer and implications.

A: There are four stages of ovarian cancer:Stage I ovarian cancer, as determinedthrough a meticulous surgery with multiplebiopsies, has not spread beyond the ovary.Over 90 percent of women with stage Iovarian cancer will be cured, and many willnot require chemotherapy. When ovariancancer has spread — stage II-IV depending

Q&A David H. Moore, M.D., Gynecologic Oncology

of Indiana, St. Francis Medical Group

upon the extent of spread — the prognosis isless favorable; furthermore, all of thesewomen will require postoperative treatmentin the form of chemotherapy.

Q: What are the warning signs orsymptoms that women should look for?

A: Ovarian cancer has been described as a“silent disease” because most women presentwith more advanced cancers — stages III orIV. Almost all women with ovarian cancerhave symptoms, but these symptoms areinitially either ignored or attributed to otherconditions. Until these symptoms becomemore severe, the diagnosis of ovarian canceris often not considered. Symptoms commonlyreported include: abdominal cramping,bloating or distention, pain and bleeding; aswell as nausea and vomiting, decreasedappetite and weight loss.

Q: What do you advise women todo to ensure early detection and pre-vention?

A: Knowing your risk for developingovarian cancer is vital for early detection andprevention. Women who come from a familybackground indicating a possible geneticpredisposition (breast-ovary family cancersyndrome) should be offered genetic counselingand testing for a possible BRCA1 or BRCA2genetic mutation.

Q: What, if any, lifestyle changeswill help reduce the risks for developingovarian cancer?

A: All women should be encouraged toexercise regularly, eat a balanced low-fat diet,maintain normal body weight and not smoke.The benefits of such a lifestyle go far beyondovarian cancer risk reduction. Pregnancy is apersonal decision and not something to berecommended as a “risk-reducing interven-tion.” Hormonal contraception reducesovarian cancer risk and should be offered toall women — who do not have specificcontraindications — as a means to reduceovarian cancer risk.

David H. Moore, M.D.


Surviving for theLong TermResources can improve quality of lifeafter a cancer diagnosis by DeAnna R. Wesley, MSW, LSW,Director, EMBRACE Program at Wishard

Hearing thewords, “Youhave cancer,”

takes an enormous tollon thousands of Indianawomen. In fact, one inthree of us are at risk ofbeing diagnosed withcancer in our lifetime.With these odds, coping with cancer hasbecome a new way of life for many.

Fortunately, with advances in education,early detection and innovative treatment,more people live longer with this disease. Inother words, some cancers once consideredfatal are now much more treatable and oftencurable, allowing for long-term survivorship.

As the director of Encouraging Meaningand Balance in a Renewing and ComfortingEnvironment, a program offering supportservices to women receiving cancer treatmentat Wishard Health Services, I know addressingsurvivorship is critical. It helps patients ensuretheir quality of life after their diagnosis andthroughout the treatment process.

Once a cancer diagnosis has been confirmed,the amount of information given to a patientcan be overwhelming. The value and meaningof life, relationships, family, economic stabilityand health become paramount, as the fear oftreatment and its side effects can lead touncertainty, fear and depression.

The goal of supporting cancer survivors isto identify, understand and validate theadverse effects of a diagnosis and treatment.It requires working collaboratively with thepatient, his or her loved ones and the healthcare team to overcome obstacles and optimizeoutcomes to ensure a heightened quality oflife with long-term survival.

Although some cancer survivors emergewith a renewed sense of hope and love of life,others struggle with uncertainty. Fear of thetreatment options and the ensuing side effects,can become overwhelming. Once treatment iscomplete, the waiting period begins to seewhether or not the treatment has been

Nearly one in four householdshas an informal caregiver ––someone who is providing for

the daily needs of a relative or friendwith advanced illness. If you are a care-giver, you may be asked to be the healthcare representative for your friend orloved one.

In this role, you will work with doctors,other medical staff and family membersto ensure your friend or loved one’swishes, including end-of-life choices,are honored if he or she is unable tomake these decisions.

These tips may help you advocate onbehalf of your friend or loved one:

> Learn as much as you can aboutyour friend or loved one’s illness, possibletreatments and outcomes.

> Talk with your friend or loved oneabout his or her choices for care.Encourage the person to put those wishesin writing.

> If you or your loved one has concernsabout his or her care, make a doctor’sappointment so the doctor can allowenough time to meet with you in anunhurried way.

> Make a list of your questions so youwon’t forget them.

> Speak up. Be clear about what youwant to say to the doctor. Make sure you

Just for CaregiversLearn how to advocate better for a friend or loved one

share your key concerns at the beginningof the meeting. Don’t minimize symptomsor situations.

> Ask questions. To make informeddecisions, ask about the goals of thetreatment plan. Sometimes a doctor’sdefinition of recovery can be differentfrom what your loved one wants.

> Listen closely to what the doctorsand other medical staff say. Take notes tohelp you remember details.

> Share your knowledge. The doctorknows medical care. You know familycare. Be honest and thorough in trackingyour friend or loved one’s symptoms;details are important.

> Separate feelings of frustration andnot being able to help your loved one asmuch as you like from your feelings aboutthe doctor.

> Seek the help of a social worker orpatient advocate. These professionals canhelp strengthen the communicationbetween you and the doctor, if necessary.

> Be assertive. If a health careprovider is unresponsive to your friendor loved one’s requests, don’t be afraidto change to a different doctor.

For more information regarding caregiving, please contact the Indiana Hospiceand Palliative Care Organization at (866)254-1910 or log on www.ihpco.org.

DeAnna R. Wesley

©2008 Indiana Hospice and Palliative Care Organization, Inc. Reprinted with specialpermission from IHPCO.


successful. Further intensifying the fear is thereality of a potential recurrence of the cancer.

In addition to these fears, many womenstruggle to find a new “normal” in their lives.As a result of the diagnosis, the dynamicsof important relationships can changedramatically. For example, during treatment,there is often a redistribution of every dayresponsibilities both at work and home.Once treatment is over, there is a need for arenegotiation of these functions.

Further, returning to work also can add tothe stress as many women feel they are treateddifferently upon their return to their place ofemployment. Many also fear discrimination,dismissal or the lack of opportunity forfuture promotions in their careers.

Finally, many women face tremendousfinancial struggles as a result of their illness.A history of cancer can result in health-relatedwork limitations, as well as the inability tosecure and maintain health insurance.Unfortunately, the economic burden of cancercan be significant. This is especially true forsingle mothers of young children.

Learning to cope can seem impossible attimes. However, with the right information andsupport, managing and enjoying life aftercancer is quite possible. Survivors and theirloved ones can overcome the many challengesof cancer by taking control.

It is important to have frequent and opencommunication with the health care team.In order to get the most out of a patient’s timewith her physicians, make a list of questionsand concerns prior to an appointment. Thisallows the patient time to define what is unclear,as well as prevent the risk of forgetting topicsand questions that she may want to discuss.

In addition, it is often helpful to takenotes during a visit to the doctor. This willallow her the opportunity to review theinformation later for clarification. Somepatients have even asked their physicians ifthey may tape record the sessions.

Another helpful tip is to ask a patient’s healthcare team to recommend books, Web sites andbrochures related to her diagnosis. These canbe invaluable resources for gaining moreinformation and a better understanding.

No woman should face cancer alone. Inaddition to a patient’s health care team,numerous local and national organizationsspecialize in offering support services towomen with cancer.

Women’s roles and responsibilitiesare not only changing but,more importantly, they are

growing. Women are multifaceted, andthe scope of responsibilities they carry iseye-opening.

When women have serious healthissues, all aspects of their lives are affected.

Today’s woman might be a singleworking homeowner or a married momwith four children and a traveling husband.Maybe she is an elderly woman caring forher ailing husband or a grandmotherraising her grandchildren.

The combinations are limitless and alltoo real. In our country alone, we witness agrowing number of single women, womenas heads of households and women caringfor parents or other adult relatives.

Consider these facts: Almost three-quarters of married women with dependentchildren work in the paid labor force inAmerica. Yet, working women still feel thepinch. Even though a U.S. Department ofLabor survey found 79 percent of women“love” or “like” their jobs, another studyfound more than four in 10 “worry a greatdeal” about balancing family and workresponsibilities.

Couple these challenges with the

Quality of LifeEvolving expectations often challenge women

by Nancy Shepard, Founder, CEO, I.W.I.N. Foundation

diagnosis of cancer, and she now is confrontedwith the overwhelming stress of coping withthe uncertainty of her future, as well as thatof her family. She may be unable to carefor herself, care for others, or earn sufficientincome.

Compounding this emotional struggle arethe financial and physical burdens traditionalcancer therapies create. The rising costs oftreatment for cancer can incapacitate awoman without health care insurance andlikewise devastate a woman with insurancewho tries to cover the common 20 percentbalance of treatment costs.

The physical effects treatment can haveon a woman are equally debilitating. Cancertherapies, such as surgery, chemotherapy andradiation, commonly cause side effects,including pain, nausea, fatigue and physicallimitations. The threat of lost employmentdue to illness and treatment side effects cansignificantly jeopardize the stability andsecurity of a woman and her family.

Fortunately, a variety of local, state, andnational resources are available to assist cancerpatients with the financial, emotional andphysical ramifications of a cancer diagnosis.Check out page 16 of this insert for a list ofresources available to help women affected bycancer, as well as their loved ones.


Indiana CancerConsortium Public-private partnershipbuilds awareness and takesaction to fight cancerby Keylee M. Wright, Director,Indiana Comprehensive CancerControl Program, American CancerSociety in partnership with theIndiana State Department ofHealth

The Indiana Cancer Consortiumis a statewide network of publicand private partnerships with themission to reduce the cancer burdenin Indiana. This public-privatecollaboration is designed to maximizeresources within the state, focus cancercontrol efforts toward areas ofpotentially significant impact, andreduce or eliminate disparities in thecancer burden in Indiana.

The ICC is an action-orientedorganization. Priorities for the ICCinclude advocating for legislation thatwill increase insurance coverage ofstandard care for cancer patientsenrolled in clinical trials. ICC alsoencourages primary care practitionersto incorporate clinical practiceguidelines to promote early detectionof cancer.

ICC’s accomplishments includeexpert consultation to the Indianalegislature regarding women’s cancerissues, creating public serviceannouncements regarding theimportance of regular breast cancerscreening and developing the IndianaCancer Control Plan. Additionally,the ICC collaborates with theAmerican Cancer Society, GreatLakes Division, and the Indiana StateDepartment of Health to update andpublish the Indiana Cancer Facts andFigures every three years.

Participation is open to all organi-zations and individuals interested incancer prevention, early detection,treatment, quality of life, data and/oradvocacy regarding cancer-relatedissues.

For more information, log onwww.indianacancer.org.

Whether we have cancer, careabout someone who does orworry about getting it in the

future, cancer touches all of our lives. As thesecond leading cause of death after heartdisease, cancer accounts for one in fourdeaths a year.

However, there are things we can do toimprove the prevention, detection andtreatment of cancer. We can make a differenceby being a participant in a clinical trial.Clinical trials contribute to knowledge andprogress against cancer.

Just as there are misconceptions aboutcancer screening tests, there are misconceptionsabout clinical trials. When people thinkabout clinical trials, many imagine “guineapigs” — participants getting inferior treatmentor a sugar pill (placebo) instead of actualmedical treatment. Many people also thinkclinical trials are for only the people whohave no other treatment options availableto them. And yet other people get beyondthese mistaken beliefs and participate inclinical trials as a way to contribute to theirown health and the health of others in thefuture.

Clinical trials are important intwo ways:

First, clinical trials contribute to knowledgeand progress against cancer. If a new treatmentproves effective in a study, it may become anew standard treatment that can helppatients. Many of today’s most effectivestandard treatments are based on previousstudy results. Examples include treatments forbreast, colon, rectal and childhood cancers.

Clinical trials also may answer importantscientific questions and suggest futureresearch directions. Because of progress

Cancer Clinical TrialsMaking a difference in many lives

by Tisha Reid, Partnership Program Coordinator, National Cancer Institute’s CancerInformation Service

made through clinicaltrials, many people treatedfor cancer are now livinglonger. However, only 3percent of U.S. adults withcancer participate in clinicaltrials — far fewer than thenumber needed to answerthe most pressing cancer questions quickly.

Second, the patients who take part maybe helped personally by the treatment(s) theyreceive. They get up-to-date care fromcancer experts, and they receive either a newtreatment being tested or the best availablestandard treatment for their cancer. Ofcourse, there is no guarantee that a newtreatment being tested or a standard treatmentwill produce good results.

New treatments also may have unknownrisks. But if a new treatment proves effectiveor more effective than standard treatment,study patients who receive it may be amongthe first to benefit. Some patients receiveonly standard treatment and benefit from it.

Learn more about cancer clinical trials

For more information, contact the NCI’sCancer Information Service at (800) 4-CANCER or log on the NCI’s Web site atwww.cancer.gov/clinicaltrials.gov or theNational Institutes of Health’s Web site athttp://clinicaltrials.gov.

You also can contact your local NCI’sCancer Information Service PartnershipProgram Coordinator for the Midwestregion. Call Tisha Reid at (317) 278-2274 ore-mail [email protected]. Make a differenceby learning more, talking to your healthcare provider or participating in a clinicaltrial.

Tisha Reid


The Indiana Joint Council forWomen’s Cancers is an associationof professional, advocacy and

support groups that do exceptional workin their respective fields. Participantsinclude doctors, nurses, researchers,advocates, social workers and volunteers.

The IJCWC was formed in the spirit ofcollaboration, not as a separate nonprofit,but as an association of groups with theprimary goal of understanding the needsof women with cancer.

The group has connected womensince its inception in August 2007 withhelpful resources and information to helpthem deal with the realities of livingwith cancer.

The group meets quarterly to shareinformation and develop materials to helpwomen in Central Indiana navigate themany programs and services available to

them. Resources aremaximized to servemore women effec-tively without dupli-cation of services.

An online calendarand a searchable database of availableresources in the cancer community areavailable at the organization’s Web site,www.ijcwc.org.

Very often, people who come through acancer diagnosis, whether personally orwith a loved one, are transformed. They areinspired by the journey and have a strongdesire to give back to the community. Ifyou or someone you know is interested inconnecting with an organization making adifference in women’s cancers, please contactthe IJCWC at [email protected] or any ofthe groups listed in the resource section onpage 16.

Indiana Joint Council forWomen’s Cancers

Professional, advocacy and support groups work together forwomen affected by cancer

by Kalah Stocker, Chair, IJCWC

Quiz Answers:(From Page 3)

1. False: Symptoms of ovarian cancermay be subtle, but they do exist. Typicalsymptoms include abdominal cramping,bloating or distention, pain and bleeding.Other symptoms include nausea and vomiting,decreased appetite and weight loss.

2. False: Heart disease is the No. 1 killerof women in Indiana as well as the UnitedStates.

3. True: HPV is a sexually transmittedvirus that can cause cervical cancer, and themost effective time to vaccinate with anyvaccine is prior to exposure.

4. True: A Pap smear does NOT detectovarian cancer. There is no reliable screeningtest for ovarian cancer. Women experiencingsymptoms that might be caused by ovariancancer should talk to their doctors aboutdiagnostic tests that could indicate whetherovarian cancer is present.

5. False: For African-American women,the five-year survival rate of breast cancer is 75percent, compared to 89 percent in whitewomen. African American women are morelikely to be diagnosed with larger tumors andmore advanced stages of breast cancer despitea lower incidence rate.

6. True: Women with a personal history ofbreast cancer — as well as endometrial andcolon cancer — have a higher risk of gettingovarian cancer. Additionally, having a familyhistory of ovarian, breast or colon cancer alsoincreases a woman’s risk for ovarian cancer.

7. True: A Pap smear looks for abnormalcells in the lining of the cervix. With routinescreening, abnormal cells are often found ata precancerous stage and with appropriatefollow-up and/or treatment cervical cancerdoes not develop.

8. False: A woman’s risk for breast canceractually increases as she gets older. Morethan three-fourths of breast cancers foundeach year occur in women older than age 50.

9. True: Almost 9.2 million sexually activepeople ages 15 to 24 are estimated to haveHPV in the United States, which translatesto nearly one in four individuals in this agegroup.

10. True: Smoking, as well as some casesof immune system suppression, has beenlinked to cervical cancer.

Kalah Stocker

American Cancer Society offers information and services tosupport those with cancer. Call (800) ACS-2345 or log on www.cancer.org.

CancerCare Assist Services provides grants to assist withhome care, childcare, transportation and other needs. Call (800) 813-HOPE or log on www.cancercare.org.

Caring Bridge offers free, personalized Web sites for anyonefacing a critical illness to keep loved ones informeds. Call (651) 452-7940or log on www.caringbridge.com.

Catherine Peachey Breast Cancer Prevention Programserves women who have had breast cancer or are considered at high risk . Call(317) 278-7576 or log on www.cancer.iu.edu/programs/breast/c_peachey.

Chemo Angels is a volunteer organization dedicated to encouragingthose undergoing chemotherapy treatments. Log on www.chemoangels.com.

Comfort Foods provides free meals to families dealing with medicalcrises. Call (317) 903-9635 or log on www.comfortingfamilies.org.

Creating Hope Inc. provides free art materials to cancer patients. Call(317) 595-8513 or log on www.creating-hope.org.

Helping Her Heal supports women with female cancers. Call(317) 873-0210 or log on www.helpingherheal.org.

The Indiana Breast and Cervical Cancer Program offersbreast and cervical screening services to low-income women. Call (800)433-0746 or log on www.in.gov/isdh/19851.htm.

Indiana Tobacco Quitline helps Indiana smokers quit. Call(800) QUIT-NOW or log on www.indianatobaccoquitline.net.

Indiana Women in Need assists women enduring breast cancertreatment by providing financial support for personal services. Call (317)475-0565 or log on www.iwinfoundation.org.

The Little Red Door Cancer Agency provides Marion Countyresidents transportation, breast prostheses, bandages, garments, wigs,hats and turbans. Call (317) 925-5595 or log on www.littlereddoor.org.

Look Good … Feel Better is a free service of the American CancerSociety that offers beauty techniques to enhance self-image during cancertreatment. Call (800) 395-LOOK or log on www.lookgoodfeelbetter.org.

Lotsa Helping Hands assists with organizing family members, friendsand others in times of need. Log on www.lotsahelpinghands.com.

Resources — emotional, medical, and social — in support of those living with cancerMaking Memories Breast Cancer Foundation grants wishes

for metastatic breast cancer patients. Log on www.makingmemories.org.

Men Against Breast Cancer educates and empowers men to beeffective caregivers when breast cancer strikes a female loved one. Call (866)547-MABC or log on www.menagainstbreastcancer.org.

National Cancer Institute’s Cancer InformationService provides the latest cancer information to the public and healthprofessionals. Call (800) 4-CANCER or log on www.cancer.gov.

The National Cervical Cancer Coalition is dedicated toserving women with, or at risk for, cervical cancer and HPV disease. Call(800) 685-5531 or log on www.nccc-online.org.

Ovar’coming Together partners with the medical communityand other cancer-oriented organizations to create awareness, provideresources and support research. Call (317) 925-6643 or log onwww.ovarian-cancer.org.

The Ovarian Cancer National Alliance works to keep ovariancancer education, policy and research issues on the agendas of nationalpolicy makers. Call (866) 399-6262 or log on www.ovariancancer.org.

Pink Ribbon Connection helps patients navigate resources, anddelivers services locally to help those coping with breast cancer. Call (317)255-PINK or e-mail [email protected].

Sisters Network is committed to increasing attention to the impactbreast cancer has among African Americans. Call (317) 823-1466 or (866)781-1808 or log on www.sistersnetworkinc.org or www.indysisters.org.

Susan G. Komen for the Cure is the world’s largest grassrootsnetwork of breast cancer survivors and activitists. Call (877) GO KOMENor log on www.komen.org.

The Wellness Community of Central Indiana providesfree support, education and hope to individuals and their families affectedby cancer. Call (317) 257-1505 or log on www.twc-indy.org.

Women In Government launched the Challenge to EliminateCervical Cancer Campaign in 2004, a bipartisan initiative. Call (202) 333-0825 or log on www.womeningovernment.org.

Young Survival Coalition of Central Indiana increasesawareness about breast cancer in young women. Call (317) 776-1766 ore-mail [email protected].

Reprints of Know Your Risks are available by calling 317.585.5858 or by mail:Weiss Communications, 6610 N. Shadeland Ave., Suite 100, Indianapolis, IN 46220.

This project is funded by the CDC PHHS Block Grant award number B01DP009019-08.Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

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as published in the october 2008 issue of indianapolis w ...as published in the october 2008 issue...

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