Summer 2010 Newsletter

In this newsletter you'll find:

Letter from the Executive Director, Founder, and Three-Time Cancer Survivor
Exciting C101 News to Share!
Battling “the Beast” Through Prevention and Early Detection
Embracing Diversity, Advancing Equality, Alleviating Disparity
Distilling Healthcare Reform
Health Reform and the Cancer Challenge
Important Dates
C101's Quarterly Advocacy Picks: A Few Great Nonprofit Resources We Love!
Contributors

Letter from the Executive Director, Founder, and Three-Time Cancer Survivor

I hope that you are having a great summer thus far and that you are reading this newsletter on a beautiful beach or at least far, far away from your workplace.

This summer, I have been spending way too much time in my office chair and since December, when my cancer returned, a chemotherapy chair. As many of you know, I had a successful 18-month run with a phase 1 clinical trial at the National Institutes of Health in Bethesda, Maryland. I was taking an exciting new drug known as a PARP inhibitor that scientists and doctors believe could be a wonder drug for ovarian cancer, triple-negative breast cancer, and other cancer types. I am not only proud I participated in my second clinical trial, I am grateful that I was in remission for over one year.

Unless caught early, ovarian cancer almost always recurs. It’s a disease that, for me, is chronic, and must be managed just like those with diabetes, heart disease, and other life-threatening diseases. Other than a few rotten days every four weeks from the effects of chemotherapy, I live a full and happy life. Working to help others fight their cancer keeps my mind off of my own. Even with my cancer returning, CANCER101 was able to make incredible strides and has met major milestones. I never let a “little” cancer hold me back.

I would like to take this opportunity to express my gratitude to every C101 donor and volunteer who has supported C101. Every penny we have received, all in-kind contributions, and donated time provided has helped C101 grow from a local breast cancer resource to a national organization now helping patients and their caregivers with any type of cancer.

We have a lot to celebrate this year, but we have little time to do so. We still need your support to meet the demand for our resources. Every day, more and more cancer centers learn about our Planners and request hundreds for their patients.

C101 gives planners to over 300 cancer centers and we need your help to keep up with the demand. Any support you can provide will be deeply appreciated.

Enjoy your summer, use plenty of good sunscreen, and be safe!

Healthy wishes,

Monica Knoll 

Exciting C101 News to Share!

CANCER101 Now Supporting People With ANY Type of Cancer

CANCER101 Planners and CANCER101.org now support people with any type of cancer, not just those with breast cancer. C101 is partnering with the National Cancer Institute (NCI) to offer our Planner recipients and Web visitors access to their 23 tumor-specific booklets that are formatted to fit right into our Planners. Web visitors can download any of these booklets with or without using our CANCER101 Planners.

The Planners still offer the same great organization and essential resources as the breast cancer–specific version, but can now help even more patients with cancer. Every year over 1.4 million Americans are diagnosed with cancer. Our Planners are distributed to patients in need for free by over 300 NCI and Association of Community Cancer Centers (ACCC) in all 50 states. Individuals can also order our Planners online at www.CANCER101.org for $18 each or download it for free.

CANCER101 Will Distribute Its 100,000th Planner This Year!

We are excited about reaching this major milestone. It’s a thrill to know that CANCER101 has been able to help so many patients and their families fight their disease. Now that our resources are designed to help so many more patients, we hope to give away 200,000 Planners each year.

We are at the mercy of sponsorships and private donations to produce enough Planners to give to the 1.4 million cancer patients in need.

Have You Seen CANCER101.org Lately?

Our Web site has been revised to help people with any type of cancer. Now you can research cancer-specific treatment plans with NexCura, find a definition from over 6,000 cancer terms created by NCI, and access their 23 cancer-specific booklets. The NCI booklets (many cancer centers give them to their patients) are loaded with information that is easy to understand and are formatted to fit into our Planners. The site also offers trusted resources, non-medical advice for patients and caregivers, and later this summer, a free online e-Planner and Smart Phone App. Visitors can also find cancer-specific national conferences, teleconferences, webinars or online chats hosted by over 100 cancer advocacy organizations. Make sure to visit www.CANCER101.org!

myCANCER101 e-Planner & Smart Phone App – Free Online Tools

This August, patients and caregivers will be able to keep important information safely online and easily accessible by any computer or smart phone. Users can store and manage appointments, contacts, tasks, medical history, test results, medications, side effects, notes, and medical bills. Tasks and medication reminders can even be assigned to friends and family. Our e-Planner will transform the way patients and caregivers manage their care. Make sure to register on our Web site (if you haven’t done so yet) to learn about our launch date!

Social Media: Twitter, Facebook, and Blogging – Oh My!

The soles of our shoes have practically disappeared from dragging our feet on these latest craze-turned-essential information portals. We’re on board now and working hard to catch up to the early birds. We promise that you will never hear about what we ate for dinner! Instead, we will tweet, facebook and blog about essential resources, important cancer news, and non-medical advice for patients, caregivers, and survivors. If you don’t twitter or facebook yet, we will send a monthly e-news roundup starting this September. Make sure to register on our Web site to receive our e-news.

Financials

C101’s 2009 990 and financials are available for review on www.CANCER101.org/financials.cfm.

Fan us on Facebook: www.facebook.com/CANCER101

Follow us on Twitter: www.twitter.com/CANCER101

Tell your friends to do the same! Like we said, we are trying to catch up and need your help to spread the word.

Battling “the Beast” Through Prevention and Early Detection
by Tim Turnham

Despite increased awareness, there are still many unanswered questions about melanoma. Researchers are struggling to understand the complexities of the disease and develop effective new treatments that will make a meaningful impact on survival. However, there is consensus on two points: that prevention is critical and early detection saves lives.

Be Kind to Your Skin

Since the majority of melanomas are associated with exposure to ultraviolet (UV) rays, being sun safe is the best way to protect yourself from this disease. The easiest way to be kind to your skin is to avoid the sun during peak hours (10 a.m. to 4 p.m.) and to use sunscreen when outdoors. Accessories such as a wide-brimmed hat, long-sleeved shirt, and sunglasses are also protective.

Severe sunburns, especially during childhood, increase your risk of developing melanoma and other skin cancer. Just one blistering sunburn doubles your chances of developing melanoma later in life.

Some are driven to tan for a perceived health benefit. Many myths exist about the need for sun exposure to maintain sufficient levels of vitamin D. However this is easily achieved through a healthy diet that includes vitamin supplements, fish, and fortified foods such as milk. 

Another key thing to remember is that wearing sunscreen is not a “blank check” for spending unlimited time in the sun. Sunscreen is just one component of sun safety. It should contain elements that block both UVA and UVB rays with an SPF of at least 30 or higher, and be used and reapplied frequently enough to do its job. 

The Earlier the Better

Most importantly, pay attention to your body. If you have a suspicious mole or one that has changed over time, have a doctor check it out. If melanoma runs in your family, make sure all of your family members visit a dermatologist once or twice a year. 

What should you look for? Anything that doesn’t look like the other moles on your body. Check for the ABCDEs:

•Asymmetry — one half doesn’t match the other

•Border — edges are ragged, notched, blurred or irregular in outline

•Color — uneven, shades of black, brown and tan

•Diameter — a change in size

•Evolving — notice if any of your moles are changing as any change may point to danger

Melanoma, the most serious type of skin cancer, is one of the fastest growing cancers in the United States. It can strike men and women of all ages, all races, and skin types. Sadly, this disease is extremely aggressive and deadly in its most advanced stages. Melanoma, in its early stages, however, can be successfully removed and monitored by regular skin screenings. Early detection truly does save lives. 

For more information about melanoma, please contact the Melanoma Research Foundation (MRF) at info@melanoma.org. The MRF is committed to the support of medical research to find effective treatments and eventually a cure for melanoma. The MRF also educates patients and physicians about prevention, diagnosis and the treatment of melanoma. 

Embracing Diversity, Advancing Equality, Alleviating Disparity
by Sarah Krüg

Healthcare inequality persists, despite the numerous efforts and resources allocated towards reducing the medical and social factors that affect health outcomes. In fact, it appears that the chasm of disparities in access to quality care and patient outcomes is widening. With a push to implement new healthcare information technology many smaller medical practices are already overwhelmed with meeting the demands of providing medical services and are thus reluctant to adopt for example, electronic health records. This situation threatens to widen healthcare disparities in the coming years. Are we truly prepared for what’s to come?

Healthcare disparities are “population-specific inconsistencies in the incidence of disease, health outcomes, and/or care access”, and refer to gaps in the quality of healthcare across racial, ethnic, gender, sexual orientation, age, and socioeconomic groups. These inequalities result in variations in the prevalence of chronic diseases, mortality and morbidity rates, spanning across preventive, diagnostic and disease management, ultimately affecting patient outcomes. Measures, data and research on health disparities are widely available; however, challenges remain in the progress that’s been made and sustainable interventions developed to alleviate these inequalities.

Racial and ethnic disparities are well documented in the US across several minority groups. In comparison to Caucasians, minority groups tend to have higher rates of cancer, diabetes, cardiovascular disease, and HIV/AIDS, among other diseases. Despite the fact that Hispanics tend to have a lower incidence of certain cancers, mortality rates from these cancers mirror that of the majority population due to diagnosis at a later stage. Those with a lesser socioeconomic status tend to have higher rates of avoidable hospital admissions and higher rates of death from cancer. These healthcare disparities can be attributed to socioeconomic and environmental characteristics of different ethnic and racial groups, access to care, barriers within the healthcare delivery system, and quality of healthcare they ultimately receive. Despite the fact that quality improvements have been made across particular core measures, healthcare inequality remains. In addition, discrimination, homophobia, and heterosexism have also led to healthcare disparities among the lesbian, gay, bisexual and transgender communities. There is also evidence of age-related disparities disfavoring the elderly in healthcare access, delivery of particular diagnostic and therapeutic interventions, and patient–provider communications, potentially leading to adverse treatment outcomes. Significant gaps also exist as they relate to gender where women often receive suboptimal care in comparison to men.

Why do healthcare disparities exist?

Quality and access to healthcare inequality persists due to reasons such as:
Financial constraints; lack of regular point of care; structural barriers (e.g., poor transportation, inability to schedule appointments during convenient hours); legal barriers (e.g., immigrant population); health literacy; language differences; lack of diversity in the healthcare workforce; patient/ provider communication gaps; provider discrimination; lack of preventive care; scarcity of providers in regions where there is a high concentration of minority populations; insurance coverage and healthcare financing system (e.g., limited coverage).

What is our role in advancing healthcare equality?

To alleviate disparities in healthcare, a public health approach must be implemented in the context of a balanced community health system, which includes health promotion, disease prevention, and early detection. Over 90% of our country’s massive health budget is spent on treating diseases and their complications, many of which are easily preventable, but less than 3% is spent on population-based prevention. A collaborative effort among various healthcare sectors to advocate for a shift in the resources is a key component to success.

Additional resources need to be dedicated to untangling healthcare disparity measures, establishing consistent data stratification, rather than relying on the traditional segmented model of race, which includes African Americans, Hispanics, and Asians. The classification of Hispanics, for instance, aggregates a wide array of populations that have a vast variation in health, lifestyle, and genetic heritage and the primary linkage is that they originate from countries that were once under Spanish rule. Should African Americans be aggregated into the same classification as Africans residing in the U.S.?

Race is a notoriously inadequate proxy for genetics in that it is such an imprecise mechanism of classifying the population. Consistent racial and ethnic data collection is imperative. A patient’s complete genetic analysis would provide a more robust platform, but the era of personalized medicine and the associated science is just beginning to emerge.

What we can do is begin to establish a customized medical model by conceptualizing a strategic blueprint to ensuring the success of a patient, taking into account personal barriers and ensuring mechanisms are put into place to alleviate those barriers. We understand widely available data (although flawed), now let’s personalize the pathways that a patient follows based upon their income, age, transportation issues, lifestyle and behavior, eating and exercise habits, co-morbidities, support network, and other limitations, etc. The customization of diagnosis, care and cure engages the patient before, during and after they are stricken with an ailment. Health systems are evolving from reactive medicine to proactively understanding and supporting individuals in managing their own health and customizing care to that individual. Health leaders need to emerge as proactive caretakers of interdependent networks that evolve as they adapt to meet and reinforce the needs of individuals.

Minimum standards for cross-cultural education and training of healthcare providers are necessary to ensure health services are both culturally and linguistically competent, promoting consistency and equality of care. Interpreter services and expanded access to care should also be incorporated into the healthcare system, with patient education playing a major role in enhancing knowledge to best access and maximize care. The patient’s cultural beliefs and traditional health practices should be considered and supported by the healthcare team so that care plans can be adjusted accordingly.

It is essential that health system sectors converge with a quest for common vision and strategy in establishing an infrastructure that provides basic health benefits within the context of alleviating healthcare inequality. This is an era in which health systems, whether a hospital, HCP, public sector agency, government or other commercial health related entity, should reap the benefits of conjointly progressing towards the goal of embracing diversity, alleviating unequal treatment and improving patient outcomes via interconnections and partnerships. As more clearly defined and enforced clinical standards are established around healthcare disparities, opportunities for innovation, continuous improvement, efficiency, integration and enhanced transparency will transpire. Essentially, this will lead to avenues of care that are centered on the needs of the patient and to strategic resource allocation that appropriately satisfies competing demands on systems to address root causes of gaps in quality and access to care. With more of a focus on care management approaches, patient empowerment and personalized medicine, the healthcare system will reorganize along more of a patient centric continuum, with an emphasis on patient safety, performance and accountability among all health sectors. By evolving from a compartmentalized approach to a cohesive framework with an overarching unified strategy, collectively we can act as catalysts in transforming the healthcare landscape and advancing healthcare equality. Collaboratively, we can begin to establish the foundation one building block at a time.

This article does not express the viewpoint of Pfizer, the author’s employer. 

Distilling Healthcare Reform
by Mario R. Nacinovich Jr., MSc, Karl U. Bucus and Alane Bearder

According to a February 2009 report by the Kaiser Family Foundation and the American Cancer Society, cancer patients face severe challenges in paying for life-saving care – running up large debts, filing for personal bankruptcy and even delaying or forgoing potentially life-saving treatment – even when they have private health insurance (Kaiser Family Foundation, 2009). A new study says about 2 million of the 12 million people diagnosed with cancer in the United States put off medical care because they cannot afford it (Stobbe, 2010). The study is being called the first to estimate how often current cancer patients and survivors have skipped obtaining care because of financial worries. It is between these two timely reports that the Patient Protection and Affordable Care Act has been passed. Whether you were for it or against it, there is no doubt this new regime will have ramifications for all current cancer patients and survivors. 

One of the major goals of this reform is to deliver affordable care to those who do not currently enjoy it. To that end, Medicaid expansion, insurance exchanges, and new subsidies promise to add anywhere between 16-32 million people to the insurance roles. More specifically, this massive increase is estimated to include 32 million newly insured individuals and 16 million new Medicaid beneficiaries. Furthermore, people with pre-existing conditions, as of 2014, will not be denied coverage. This is a departure from the past where some patients, even those having private health insurance at the time of their cancer diagnosis, did not have protection from high out-of-pocket costs – leaving them with large debts to cover their treatment costs and forcing some to skip or delay necessary treatments (Kaiser Family Foundation, 2009). 

A recent Commonwealth Fund analysis showed that the Patient Protection and Affordable Care Act will technically deliver on all three of the goals President Obama set forth when Congress began crafting reform legislation last year: 

•expand access to affordable health insurance for those without coverage;
•increase the affordability of insurance for those who already have it; and
•slow the rise in healthcare costs for individuals, families, and employers while not adding to the federal budget deficit (Davis, 2010)

A note regarding deficit neutrality is in order, though, because healthcare reform legislation is not likely to end with the passage of this bill. First, this bill does not include what is known as the “doc fix” (CBO), an adjustment in mandated cuts to physician Medicare reimbursement that has been a fait accompli since 1997, a process that promises to continue. This “doc fix” is a priority for Congress today (Kaiser Health News), and its passage would drive the cost of healthcare reform, in the aggregate, into the red (Associated Press).

Edward M. Miller, Dean and Chief Executive Officer of Johns Hopkins Medicine, recently summed up the final legislation very simply when he stated that “the central themes of the new law are clear: coverage, quality, and cost” (Johns Hopkins Medicine, 2010).

The inclusion of those with pre-existing conditions into the insurance pool by 2014 represents large potential costs to issuers. So in order to ensure they do not go bankrupt somewhere around 2015, this legislation also includes an individual insurance mandate. This means every American that does not carry insurance, but can afford it, must purchase insurance or pay a tax to the government for the privilege of declining to carry coverage.

One of the goals of this reform was also to “bend the cost curve” of care. In addition to increased access, the other main driver of the effort to reform our care delivery system was the remorseless increase in the cost of healthcare. The amount of money Americans devote to healthcare has been taking up more and more of their annual budgets as the rate of this increase exceeds both inflation and wage growth.

Currently, the reform bill features cost-cutting and revenue-generating mechanisms that are meant to offset new coverage subsidies. Some believe that despite the rampant inefficiencies and extremely high costs of healthcare in the United States, it is still possible to make the American healthcare system even more inefficient and more costly (Fodeman & Book, 2010). When it comes to cost cutting, the most prominent example is the goal to find $500 billion in Medicare savings over ten years. Most people agree that Medicare currently is responsible for $50 billion per year in waste and fraud, even though recouping it has always been elusive and politically delicate. Not many currently in or seeking a seat in Congress want to run for office being portrayed as an enemy of Medicare. While real health reform would allow control of costs and improvements in care that would ultimately empower patients to purchase their own care and expand their menu of choices, and create a national market for health insurance (Fodeman & Book, 2010), current and former cancer patients are certain to be thankful for a system that will hopefully not fail them when they need it to protect them the most – when they are in need of life-saving treatments.

Bibliography

Associated Press. (2010, March 19). Medicare Fix Would Push Health Care Into the Red. Retrieved June 23, 2010, from ABCNews.com: http://abcnews.go.com/Business/wireStory?id=10152324.

Davis, K. (2010, June 10). Who Is Helped by Health Reform? Retrieved June 22, 2010, from The Commonwealth Fund: http://www.commonwealthfund.org/Content/Blog/Who-Is-Helped-by-Health-Reform.aspx.

Fodeman, J., & Book, R. A. (2010, February 17). “Bending the Curve”: What Really Drives Health Care Spending. Retrieved June 22, 2010, from The Heritage Foundation: http://www.heritage.org/Research/Reports/2010/02/Bending-the-Curve-What-Really-Drives-Health-Care-Spending.

Johns Hopkins Medicine. (2010, June 21). Hopkins Medicine Dean/CEO Edward Miller Discusses Health Care Reform at the National Press Club. Retrieved June 22, 2010, from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/mediaII/national_press_club.html.

Kaiser Family Foundation. (2009, February 5). New Report Highlights Health Care System’s Financial Squeeze on Cancer Patients. Retrieved June 22, 2010, from The Henry J. Kaiser Family Foundation : http://www.kff.org/insurance/insurance020509nr.cfm.

Kaiser Health News. (2010, June 23). Democrats Stymied on Medicare Physician Pay ‘Fix’. Retrieved June 23, 2010, from Henry J. Kaiser Family Foundation: http://www.kaiserhealthnews.org/Daily-Reports/2010/June/23/Doc-Fix-And-Extenders-Bill.aspx.

Stobbe, M. (2010, June 13). Study: Millions of Cancer Survivors Put Off Care. Retrieved June 22, 2010, from Google: http://www.google.com/hostednews/ap/article/ALeqM5irxd94N2Maqjt6E3z3XjCJ5uwvtwD9GAQJO00.  

Health Reform and the Cancer Challenge 

For many Americans, the physical and emotional challenges of battling cancer all too quickly expand into devastating financial burden. As a result, over 26% of Americans diagnosed with cancer have chosen to forgo, delay or change treatment options because of the cost – even with an insurance plan. According to the American Cancer Society Cancer Action Network (ACS CAN), health reform legislation includes approximately 160 provisions specifically intended to benefit current and future cancer patients, survivors and their families. Highlights of issues addressed through reform include:

Problem: For those diagnosed with cancer, the cost (or lack) of insurance and treatment can jeopardize health and financial security.

Provisions:
•Make insurance more accessible for uninsured cancer patients, more stable for the currently insured, and limit the financial burden of care.
•Provide immediate access for the uninsured with a serious pre-existing condition through a high-risk pool until full legislation takes effect.
•Guarantee issue and renewability of health insurance regardless of health status.
•Limit deductibles, out-of-pocket maximums, and lifetime maximums; increase policy options for those not covered by employer insurance through insurance exchanges.
•Expand eligibility for Medicaid and improve reimbursement rates for primary care providers.
•Improve Medicare coverage for prescription drugs, wellness visits and prevention plans, as well as cost sharing and deductibles for some services.

Problem: Our current healthcare system minimizes quality-of-life issues for cancer patients and survivors, adding complexity and limiting care options.

Provisions:
•Extend HHS’s Patient Navigator program, which provides outreach, assistance, and education for cancer patients.
•Require commercial (not private) and federal employee insurance to cover patient participation in approved clinical trials.
•Prioritize improvement to quality of healthcare, care coordination, and chronic disease management.
•Expand research on pain management and providers’ understanding of how to access and appropriately treat pain.
•Provide training and career development grants across provider categories, especially those focused on team-based care, including physicians, nurses, social workers, and psychologists.
•Encourage standardization of definitions and coverage documents, and assists
patients with coverage appeals processes.

Bibliography

Affordable Care Act: Clinical Trials. (2010, April 1). American Cancer Society Cancer Action Network. Retrieved June 23, 2010, from http://acscan.org/pdf/healthcare/implementation/factsheets/hcr-clinical-trials.pdf.

American Cancer Society Cancer Action Network. (n.d.). American Cancer Society Cancer Action Network. Retrieved June 23, 2010, from http://www.acscan.org/.

Fighting Back Against Cancer: Health Insurance Reform & Cancer in America. (n.d.). Health Reform. Retrieved June 23, 2010, from http://www.healthreform.gov/reports/fightingcancer/index.html.

Implementation Tools and Fact Sheets. (n.d.). American Cancer Society Cancer Action Network. Retrieved June 23, 2010, from http://acscan.org/healthcare/learn.

The Need for Health Care Reform Through the Eyes of Cancer Patients: A National Poll. (2009, May 11). American Cancer Society Cancer Action Network. Retrieved June 23, 2010, from http://acscan.org/pdf/healthcare/reports/healthcare-cancerpoll.pdf.

The New Health Care Reform Law Through The Cancer Lens: Key Provisions Affecting Cancer Patients and Survivors. (2010, March 30). American Cancer Society Cancer Action Network. Retrieved June 23, 2010, from http://acscan.org/pdf/healthcare/implementation/HCR-cancer-provisions.pdf.

Important Dates

SEPTEMBER
•September 14: An invitation-only event to thank and honor CANCER101’s major sponsors and donors.
•National Prostate Cancer Awareness Month
•Childhood Cancer Month
•National Ovarian Cancer Month
•Gynecologic Cancer Awareness Month
•Leukemia and Lymphoma Awareness Month

OCTOBER
•October 8-9: National Coalition of Oncology Nurse Navigators 2nd Annual Conference
•National Breast Cancer Awareness Month

JUNE 2011
•June 4: The Hunt! A C101 Fundraiser. Save the date!

Monica Knoll’s Fall 2010 Speaking Engagements

Breast Cancer East Africa Initiative September 20-24, 2010
National University of Rwanda
Kigali, Rwanda
www.breastcancerafrica.org

The National Coalition of Oncology Nurse Navigators
October 8-9, 2010
Hilton Branson Convention Center
Branson, MO
www.nconn.org

The Pastures Retreat Weekend Workshop and Walk for Breast Cancer
October 22-24, 2010
Southfield, MA
The Berkshires
(space is limited)
www.thepastures.org

The Hunt!
Save the date: June 4, 2011

It’s a treasure, scavenger and photo hunt combined, followed by a celebration that will include delicious food and cocktails. We anticipate 800 guests and hope to raise $200,000 from our first hunt. If you would like to sponsor, volunteer, or donate exciting auction items, prizes, venue, liquor, food, music or invitations, go to www.CANCER101.org/TheHunt for more information. Or call us at 1(646)638-2202.

C101’s Quarterly Advocacy Picks:
A Few Great Nonprofit Resources We Love!

The Melanoma Research Foundation:
www.melanoma.org

The Melanoma Research Foundation (MRF) is the largest independent, national organization devoted to melanoma in the United States. The MRF is committed to the support of medical research for effective treatments and eventually a cure for melanoma, as well as the education of patients and physicians about prevention, diagnosis, and the treatment of melanoma. The MRF is an active advocate for the melanoma community, helping to raise awareness and the need for a cure. The MRF’s Web site is the premier source for melanoma information seekers. For further information, please call 1-800-673-1290 or email info@melanoma.org.

Imerman Angels:
www.imermanangels.org

Imerman Angels gives cancer patients one-on-one support from people who have been in their exact position. Through Imerman Angels, a current cancer patient is matched up with someone who has survived their exact type of cancer, creating a unique mentorship program that shows patients that they are not alone in their experience. The completely free service is available not only to patients, but also to caregivers, and no one is ever turned away.

MyLifeLine:
www.mylifeline.org

MyLifeLine makes communicating with loved ones easier by providing patients with a free, customized, personal and private Web site. Patients can use their Web site to post updates on their treatments, and loved ones can read the updates and leave messages. Patients can also use their Web site to check their email, organize their schedule, post photos, and ask for donations to help with costs during treatment. When you sign up, make sure to click on CANCER101 when asked how you heard about www.mylifeline.org.

Contributors

Executive Director/Founder
Monica Knoll

Managing Editor
Susan Cuozzo
Vice President
AXON Communications
scuozzo@axon-com.com

Creative Director
Greg Betza
gbetza@optonline.net

Contributing Writers

Alane Bearder
Marketing/Creative Principal
Alane Bearder Creative Direction, Inc.
alaneb@mac.com

Karl U. Bucus
Founder and Principal
KUB Consulting
karl.bucus@gmail.com

Sarah Krüg
C101 Board of Directors Member
Pfizer, Inc.

Mario R. Nacinovich Jr., MSc
Managing Director
AXON Communications
mnacinovich@axon-com.com

Tim Turnham
Executive Director
Melanoma Research Foundation

Fall 2010 Newsletter

In this newsletter you'll find:

Letter from the Executive Director, Founder, and Three-Time Cancer Survivor
Spotlight on a Survivor
Clinical Trials Crossroads
Clinical Trials 101
Barriers to Clinical Trial Recruitment & Retention
October is Breast Cancer Awareness Month!
Important Dates
Contributors

Letter from the Executive Director, Founder, and Three-Time Cancer Survivor

Greetings from Kigali, Rwanda!

I am here on a personal mission to learn about the needs of cancer patients. In addition, I have had the great fortune to stay with the Shaws, an incredible couple who have rescued and are raising 20 children. The nine littlest ones live with them in their home, and the older ones live an hour away and go to school. So I suppose I now have three missions: To help those with cancer, to help the Shaws keep food on the table for their 20 adorable children, and of course, CANCER101.

Yesterday I was invited to speak to over 20 breast cancer survivors. I did little talking and instead listened to their plight. I was shocked to learn that every woman in the room had to leave Rwanda to find chemotherapy and/or radiation treatments because there are no treatments available in their own country. Many went to neighboring Uganda to seek treatments. Clearly, only those who can afford the expenses of travel and treatments get the medical attention that they need. The thousands of women and men without the means simply go without.For most Africans, cancer is a death sentence.

One woman told us that she had planned to have her mastectomy today but wanted to come to the meeting instead. She teared up when she learned that there might be more treatments after her surgery. She had no idea. She is a seamstress with six children and a husband who is slipping away from liver cancer. She wonders what will become of her and her children.

Most Americans are fortunate to have access to care and choices to make regarding treatments. It is my hope that someday, in the very near future, the pharmaceutical industry will be able to deliver free treatments to Rwanda.

For those of us who have had cancer or are currently in the fight, it is easy to feel sorry for ourselves. Traveling to Rwanda has made me feel more fortunate than ever. Yes, I am stage 4 and living with cancer, but I have lived a wonderful life. Listening to these women speak about the lack of medical care for cancer patients and looking into the beautiful eyes of these little children makes me feel even more empowered to help those with cancer - both in the United States and abroad. I look forward to sharing more about my experiences here in the next newsletter.

Healthy wishes,

Monica Knoll 

Spotlight on a Survivor
by Aracely Delgado

CANCER101 frequently receives testimonials from patients who have used our Planner. For this issue, I contacted one such survivor, Julie Ragusa from Fort Myers, Florida. She discussed how her experience using our Planner has helped her feel less overwhelmed and more empowered to take control over her diagnosis.

Aracely: How old are you?

Julie: I’m 41 years old.

Aracely: What do you do for a living?

Julie: I’m a registered nurse. I’ve been a nurse for 21 years. My work has mainly been in pediatrics. Before I was demoted due to my breast cancer, I was working as a visiting nurse for a home health agency.

Aracely: When you were first diagnosed with breast cancer, what went through your mind?

Julie: Honestly, I was in denial for many days, and then it hit me and I was sad. I kept saying that I wouldn’t be convinced till I had my biopsy results.

Aracely: What were your thoughts when you were given the CANCER101 Planner? (Julie received her planner at Lee Memorial Health System from her cancer navigator, Dara Leichter.)

Julie: I loved it. Since I am such a planner myself, I immediately put all my MD cards and contact phone numbers in there. I keep it on me all the time and take it with me to all my appointments. I especially love the binder [the 5-pocket folder that comes with the Planner], where I can keep copies of records, bills, etc. It has been very helpful.

Aracely: How has it been using the Planner with your healthcare team?

Julie: It has been great because there have been times when one of my MDs doesn’t have a copy of one of my tests and all I do is pull it out of the binder and say, “Here ya go.” Dara has been awesome. She was very supportive and I was so glad I had a chance to meet with her. She supplied me with an abundance of information and immediately got me going on trying to get some financial help.

Aracely: How has the Planner helped you?

Julie: It keeps me organized instead of having piles of papers scattered all over the place. It keeps my MD numbers handy in one place. I also love the calendar because it helps me keep track of my appointments.

Aracely: What part of the Planner do you find most valuable?

Julie: The dividers [5-pocket folder]. As soon as I get a bill or a receipt, I put it right in the designated divider. It’s nice because it keeps everything together.

Aracely: What have others (family, friends) thought of the Planner?

Julie: They like it. I just grab it and go to appointments instead of running around looking for stuff.

Aracely: Have you recommended the Planner to others?

Julie: I haven’t had the opportunity to meet anyone yet seeking help. But I plan on paying it forward so I can help others with their fight as well.

Aracely: Any additional thoughts or comments?

Julie: Thank you for providing this book and Planner. I am very grateful.

Our Planners are provided free of charge to patients and caregivers in need by over 300 hospitals and cancer centers in all 50 states. Individuals can also order our Planners online for $18 or download it for free. To learn more about our Planners, please visit us at www.CANCER101.org/Planner.

Clinical Trial Crossroads: Intersection of a Demographic Shift, Personalized Medicine & Disparities in Care
by Sarah Krüg

A Shifting Demographic

We are only a few years away from the onset of a tremendous demographic shift in this country. In 2010, it is estimated that approximately one in three persons in the US will belong to a non-Caucasian minority group. The US Census Bureau recently reported that the minority population accounts for 48.6% of children born in the US between July 2008 and July 2009, suggesting that minority births will soon eclipse births of Caucasians.¹ By the year 2020, it is projected that racial/ethnic groups currently classified as “minorities” will account for 40% of the US population. Some predict that this demographic milestone may be reached in the next few years and could potentially happen as early as 2011. Additionally, the traditional divide between black and white has evolved into one that is a more complex mix of race, language, and religion. One can argue that the classification of “Caucasian” is also somewhat flawed in that it includes any person who is of European, Middle Eastern, or North African descent, which are very different populations. The political, social, and health implications of this demographic transition are profound—are we prepared for what the future holds?

The Advent of Personalized Medicine

The completion of the sequencing of the human genome has led us into a new era—one that increasingly intersects our underlying genetic and molecular makeup with race and ethnicity to carve out a new understanding of cancer risk and occurrence in different populations. There is abundant epidemiological evidence that race and ethnicity are associated with differences in cancer incidence and mortality. Emerging evidence also shows the presence of inter-ethnic variations in terms of the specific identity and/or the prevalence of pharmacogenetic markers that are found in populations living in different geographic areas.² While cancer is the unifying nemesis of all ethnic groups, the underlying ethnic-dependent genetic variation may also result in different cancer phenotypes and behaviors. For example:

•The transforming EML4-Alk fusion gene has been associated with lung cancer and may be a potential target of therapy in patients with nonsmall cell lung cancer (NSCLC), which accounts for 80% of lung cancer cases. EGFR mutations have been shown to be more frequently associated with NSCLC in Asian populations.

•BRCA1 and BRCA2 are genes that, when mutated, significantly increase risk of developing breast and ovarian cancer. Genetic studies of hereditary breast cancer show that the mutation of Breast Cancer Susceptibility Gene-2 (BRCA2) is more prevalent in Asian patients compared to European patients. BRCA1 mutation is more common in the latter.

Genome sequencing enables us to pinpoint the exact molecular aberrations of each tumor and why it may affect some populations more so than others.³ Unique genetic features associated with racial groups, in combination with environmental factors, can influence carcinogenic mechanisms and lead to biologically important variations in the molecular profile of a tumor.⁴

Bottom line: Cancer therapy is not “one size fits all.” Although they make look similar under the microscope, no tumors are identical, and their molecular aberrations can vary greatly. It is important to understand how therapeutic approaches can result in variations in the efficacy and safety profiles of different subpopulations. Understanding molecular aberrations, an individual’s unique gene expression profile, and patterns that may be identified across certain racial and ethnic groups allows researchers to target tumors with the right drugs and dosages that are most likely to have a positive effect on the right patients.⁵

The spotlight is on personalized medicine, which is a medical approach that leverages the science of genomics and proteomics, accounting for an individual patient’s genetic, behavioral, and environmental profile to select, optimize, and enable tailored approaches to preventative and therapeutic care. Personalized medicine or “P4”medicine—powerfully Predictive, Personalized, Preventative, and Participatory—is a shift from the traditional practices of reactive medicine to a science that is more proactive.^6,7 The Personalized medicine movement allows for efficiencies in terms of both improved efficacy of therapeutic approaches that are responsive to patients’ genetic, behavioral, and environmental profiles, as well as reduced health-care related costs. Personalized medicine applied to cancer research would take into account the underlying genetic and molecular framework of both the individuals who get cancer and the cancers themselves, and begin to identify disease patterns across certain racial/ethnic groups.

Demographic Shifts + Personalized Medicine = Clinical Trial Disparities

The benefits of personalized medicine in improving discovery and treatment and fostering further targeted developments require greater diversity in clinical trials. The biodiversity and heterogeneity of the US population underlies the importance of multi-ethnic clinical trials. Approximately 2-3% of adults with cancer in the US participate in clinical trials, and the minority population represents the smallest percentage of participation, even though they bear a disproportionate burden of cancer, morbidity, and mortality.^8,9 Adequate recruitment, representation, and retention allow for generalization of findings and ethnicspecific analyses; however, the minority population has been and continues to be significantly under-represented in clinical trials. Under-representation of minorities in clinical research means that treated populations may have been under-studied or never studied. From a scientific perspective, diverse representation is necessary to test for differences in outcomes and to ensure safety and efficacy of cancer therapies across a range of biological and genetic characteristics.⁹ A focused effort is being directed towards targeted therapies and through a more precise science, clinical researchers will improve alignment of smaller trials to patients with a particular tumor profile, who are most likely to benefit. A better understanding of genetic abnormalities and drug targets will lead to fewer misguided drug development projects and reduce costs and wasted efforts in the long run. Molecular signatures and genetic profiles need to be accounted for in the design, implementation, and evaluation of clinical trials to ensure the success of future therapeutic approaches.^3,4,9 If a drug is not successful, researchers can then determine whether it isn’t effective because the target is inappropriate or if genetic variances prevent the drug from hitting its target in some individuals.

The importance of recruiting and retaining diverse populations, the multitude of challenges that complicate an equitable selection of clinical trial participants and the ethics of a more inclusive participant population have been well documented.¹⁰ To remedy disparities in clinical trial representation, it is imperative that we utilize a proactive systems-based approach that builds upon grassroots awareness and involvement, as well as community leadership working in partnership with local and national leadership to collaboratively make modifications in behavior, attitudes, systems, and policy.

A multi-faceted constellation of endeavors across sectors is crucial in alleviating disparities. If cancer burden is greater in a particular population, further research should be conducted to oversample that population. Alternatively, proportional sampling that reflects the demographics of a particular region can more accurately reflect the disease burden on a specific population.¹⁴ As we further grasp genetic variation among a similar grouping of individuals, it may help to deconstruct the imprecise notion of “race” and similar group classifications. In addition, measurements that capture the full range of patient/provider experiences around clinical trial awareness, decisionmaking determinants, and adherence to recommendations would also help in our collective efforts to address inequalities.¹⁵

•What if the reason for refusal to participate could be addressed with minor tweaks to the protocol that would not compromise the scientific validity of the outcome?

•Are we considering barriers that extend beyond the patient and the provider?

•Will the personalized medicine movement aggravate healthcare disparities, based on costs associated with individually tailored regimens, and a patient’s socioeconomic constraints?

•Can the healthcare system accommodate focused clinical trial accrual and retention efforts in centers of excellence and maintain high quality, community-based care for all patients regardless of race and ethnicity?

•Can a more targeted science, coupled with strategies to address disparities, increase clinical trial accrual participation and alleviate inequalities as they relate to racial and ethnic minority groups?

The face of America is evolving, and we collectively as a community, must explore innovative ways to study the complex interplay between genetic and environmental factors in the etiology of various health outcomes and how disease patterns in particular groups may play a role. It is up to you as a patient—as a physician—as a healthcare system—as a broader community—to help address the challenges that lie ahead.

Bibliography

1. US Census Bureau, Population Division. http://www census.gov/population/www/pop-profile/natproj.html.

2. Tang H, et al. American Journal of Human Genetics. 2005;76:268–275.

3. Rofaiel S, Mousa S. Pharmacogenomics and Personalized Medicine. 2010:129–143.

4. Blackman D, Masi C. Journal of Clinical Oncology. 2006;24:2170–2178.

5. Evans W, Relling M. Nature. 2004;429:464-469.

6. Shastry BS. The Pharmacogenomics Journal. 2006;6:16–21.

7. Lee SS, Mudaliar A. Science. 2009:323–342.

8, 12.. Education Network to Advance Cancer Clinical Trials. http://www.enacct.org/training-resources.

9. Felder TM, Pena GD, Chapital BF. Prev Chronic Disease. 2009;6(4).

10. Wencke J. Nature Reviews Cancer. 2004;4:79–85.

11. Agency for Healthcare Research and Quality: National Healthcare Disparities Report 2007. Rockville, MD, US Department of Health and Human Services, Agency for Healthcare Research and Quality, AHRQ Pub. No. 08-0041, 2008.

13. Adams L, et al. Journal of Clinical Oncology. 2004;22(4):730–734.

14. Lee SS, Mountain J & Koenig BA. Yale J. Health Policy Law Ethics. 2001;1:33–75.

15. Goss E, et al. Journal of Clinical Oncology. 2009;27(17):2881–2886.

Clinical Trials 101

Q: What is a cancer clinical trial?

A: Clinical trials are important medical research studies, in which patients voluntarily participate to help discover and test new methods of prevention, screening, diagnostics, treatment, or long-term survivorship for cancer. Clinical trials are the link between laboratory discoveries and researchers’ ability to improve the way we prevent, detect, and treat cancer.

Q: What are phases of a clinical trial?

A: Clinical trials are conducted in a series of steps referred to as phases, and each phase is designed to answer a specific research question. Phase I trials evaluate safety; phase II trials measure effectiveness; phase III trials test against the best existing treatment; and phase IV trials evaluate new uses or long-term effects of treatment.

Q: What is a randomized clinical trial?

A: Randomization refers to a study where participants are assigned by chance to either a standard of care treatment group (control group) or investigational treatment arm to compare the different cancer treatments. Neither the researchers nor participants choose which group the patient is entered into, which is one step in preventing bias in cancer research.

Q: What is the difference between standard therapy and experimental/investigational therapy?

A: Standard therapy is the treatment that experts agree is appropriate, accepted, and widely used. Experimental or investigational therapy refers to a drug (new drug, new dose, combination with other drugs, or route of administration) or procedure that has undergone basic laboratory testing and received approval from the US Food and Drug Administration (FDA) to be tested in humans to prove safety and efficacy for diagnosis, prevention, or treatment of a defined disease/condition. A drug may be approved by the FDA for use in one disease and considered experimental in other diseases.

Q: Are clinical trial patients treated like "guinea pigs"?

A: Safeguards have been put in place to protect research participants to ensure that legacy practices are not repeated. The informed consent process is an important step of a clinical trial where potential participants learn the purpose of the study, what will happen during the trial, potential risks and benefits, and individual rights in language that is understandable. The informed consent process continues throughout the trial and study participants must be informed of any new benefits, risks or side effects that may surface.

Q: Are clinical trials use to test unproven treatments?

A: Clinical trial participants are monitored closely by a member of the medical team. Each trial has a detailed treatment plan (protocol), which must be followed. New treatments must go through a rigorous scientific evaluation and approval process to ensure patient rights and safety before they can begin. In addition, all studies must undergo laboratory preclinical testing, which helps identify treatments that may be ineffective or have side effects that are not tolerable.

Q: Do clinical trials cost more than routine patient care?

A: Studies have shown that routine patient care associated with clinical trial participation is about equal to costs for patients who don’t participate in trials. Most insurers cover normal costs associated with cancer clinical trial treatment. Many states mandate coverage of clinical trial treatment.

Q: Won't my doctor suggest a clinical trial if I am eligible for one?

A: The primary reason that patients participate in clinical trials is because their physicians suggested it; however, many physicians don’t recommend clinical trials to their patients. Patients can take an active role in their healthcare by using a variety of resources to find a trial for which they may be eligible.

Q: Are clinical trials only available for current cancer patients?

A: Cancer clinical trials exist for all types and stages of cancer from cancer prevention through long-term survivorship. There are trials available for healthy people that are at higher risk of cancer due to family history. There are also trials available for people who have had cancer and want to prevent recurrence or reduce the risk of developing a new type of cancer.

Top 5 Clinical Trial Myths

Myth #1: Clinical trial patients are treated like “guinea pigs.”

FACT: Safeguards have been put in place to protect research participants to ensure that legacy practices are not repeated. The informed consent process is an important step of a clinical trial where potential participants learn the purpose of the study, what will happen during the trial, potential risks and benefits, and individual rights in language that is understandable. The informed consent process continues throughout the trial and study participants must be informed of any new benefits, risks or side effects that may surface.

Myth #2: Clinical trials are used to test unproven treatments.

FACT: Clinical trial participants are monitored closely by a member of the medical team. Each trial has a detailed treatment plan (protocol), which must be followed. New treatments must go through a rigorous scientific evaluation and approval process to ensure patient rights and safety before they can begin. In addition, all studies must undergo laboratory preclinical testing, which helps identify treatments that may be ineffective or have side effects that are not tolerable.

Myth #3: Medical care associated with clinical trials costs more.

FACT: Studies have shown that routine patient care associated with clinical trial participation is about equal to costs for patients who don’t participate in trials. Most insurers cover normal costs associated with cancer clinical trial treatment. Many states mandate coverage of clinical trial treatment.

Myth #4: Doctors will always suggest cancer trials as a treatment option for an eligible patient.

FACT: The primary reason that patients participate in clinical trials is because their physicians suggested it; however, many physicians don’t recommend clinical trials to their patients. Patients can take an active role in their healthcare by using a variety of resources to find a trial for which they may be eligible.

Myth #5: Only cancer patients can participate in clinical trials.

FACT: Cancer clinical trials exist for all types and stages of cancer from cancer prevention through long-term survivorship. There are trials available for healthy people that are at higher risk of cancer due to family history. There are also trials available for people who have had cancer and want to prevent recurrence or reduce the risk of developing a new type of cancer.

Bibliography

Education Network to Advance Cancer Clinical Trials. http://www.enacct.org/training-resources.

Coalition of Cancer Cooperative Groups, Knowledge is Power: Educate Yourself Now on Cancer Clinical Trials

Coalition of Cancer Cooprative Groups. http://www.cancertrialshelp.org/default.aspx.

Barriers to Clinical Trial Recruitment & Retention

Patient Barriers

•Cost/lack of insurance
•Cultural barriers
•Lack of awareness
•Language/linguistic differences
•Complex clinical trial forms
•Socioeconomic obstacles (transportation, unpaid work leave, child care)
•Study design/eligibility criteria
•Mistrust

Physician Barriers

•Administrative/financial burden to their practice
•Assumption that patient is disinterested
•Lack of awareness
•Discrimination
•Belief that standard therapy is best option
•Lack of recruitment skills or resources
•Lack of incentive–extra effort
•Fear of losing control of patient

Healthcare System Barriers

•Lack of bilingual or minority healthcare providers
•Poor relationship between medical institution and community
•Lack of outreach strategies
•Health literacy--not just about reading levels
•Lack of cultural competence healthcare training
•Lack of policies requiring appropriate inclusion of underrepresented populations in clinical trials
•Lack of IRB training on disparities in clinical trials
•Lack of consideration of minorities in design, implementation, and evaluation of clinical trials

Additional information on clinical trials is available at:

Education Network to Advance Cancer Clinical Trials http://www.enacct.org
National Cancer Institute’s Cancer Information Service http://www.cancer.gov/clinicaltrials
Coalition of Cancer Cooperative Groups http://www.cancertrialshelp.org
MedlinePlus: Clinical Trials http://www.nlm.nih.gov/medlineplus

October is National Breast Cancer Awareness Month, and Early Detection Can Save Lives!

Oath to Me: Chronicles of an Empowered Patient by Sarah Krüg

Quarter past nine, my knees buckle and go weak,
I make my way to reception—hardly able to speak.
I’m here for a sono/mammo I meekly declare,
That time of the year—dreaded scan of the “glam” pair.
Taking my seat, I demurely peer around the crowded room,
All twice my age-mature garden surrounding a fresh bloom.
Twisted knots and belly flops—I try and maintain composure,
A few minutes until game time—and a bit of indecent exposure.
A tangled web of genetics won’t seal my fate,
Annual exams early on-surely a step towards my escape.
The wrath of cancer has taken its toll—across the family tree,
I take the bull by the horns won’t “just let it” happen to me.
Empowered with knowledge and action—I will fight back,
Carefully masterminding my mode of attack.
Rigorous screenings—prevention and early detection are key,
Measures of success in my healthy lifestyle decree.
Wine in moderation and a health diet I strictly maintain,
Enjoying life to the max—laughter, friends and long walks in the rain.
Physical activity—I always find a way to work it in,
Mind over matter, I am truly destined to win.
My “glam pair” is now coated in a gelatinous sheath,
As a frigid probe, gingerly scopes what’s beneath.
Holding my breath, I’m then pressed against a cool metal plate,
As what little is there is scanned—holding my fate.
Quarter to 10, I shed the dowdy hospital gown,
A fashion faux pas—duds not suitable out on the town.
Piece of cake—I think to myself—as I book next year’s date,
Same time, Same place—I promise not to be late.
“Veni, vidi, vici”—immediately comes to mind,
That fear of the unknown—I’ve left it all behind.
Oath to me: I solemnly swear to do my part,
Never take health for granted and play life wicked smart!

Did you know...?

Breast cancer is the leading women’s cancer in the US, accounting for nearly 1 in 4 cancers diagnosed.

Approximately 275,000 new cases of breast cancer will be diagnosed each year.

The highest rates of breast cancer globally occur in North America & Western Europe—almost 5 times more common than in Asia.

Women raised in third-world countries have the lowest worldwide breast cancer risk. Black women have a lower incidence of breast cancer than Caucasian women, yet Black women are more likely to be diagnosed at a later stage of cancer than Caucasian women.

Men can get breast cancer, too.

Contrary to popular belief, only 10% of breast cancers are inherited.

Breast cancer incidence and death rates generally increase with age – approximately 95% of new cases occur in women ages 40 or older. The median age at the time of breast cancer diagnosis is 61 years.

Alcohol consumption is linked to a rise in breast cancer risk that increases with the amount of alcohol consumed.

An MRI (magnetic resonance imaging) uses a powerful magnetic field, radiofrequency pulses, and a computer to produce detailed pictures of internal body structures.

A mammogram uses conventional x-rays to image the breast which is compressed to allow for a clear picture. A breast ultrasound uses radar-like technology to generate images, as sounds waves travel through breast tissue.

Signs and symptoms of breast cancer may include any new mass, lump or breast change including swelling of all or part of the breast, skin irritation or dimpling, breast/nipple pain, nipple retraction, redness, scaliness or thickening of the nipple or breast skin.

BRCA is a genetic blood test for a breast cancer susceptibility gene for certain forms of inherited breast cancer.

Only 53% of women aged 40 and older reported having a mammogram within the past year. Inadequate screening is associated with advanced tumor size and stage at diagnosis.

Women at increased risk of breast cancer may benefit from additional strategies such as earlier initiation of screening, shorter screening intervals, or the addition of screening modalities such as ultrasounds or MRIs.

Bibliography

American Cancer Society. Cancer Facts & Figures 2010. Atlanta, GA: American Cancer Society; 2010.

Smith RA, Cokkinides V, Brawley OW. Cancer Screening in the U.S., 2009: A Review of Current American Cancer Society Guidelines and Issues in Cancer Screening. CA Cancer J Clin. 2009; 59(1):27-41.

McGinnis JM, Foege WH. Actual Causes of Death in the United States. JAMA. 1993; 270:2207-2212.

National Cancer Institute.What You Need to Know About Breast Cancer. 2010

Chan D. Breast Cancer: Real Questions, Real Answers, 2006; 2-54.

http://www.cancer.org

http://www5.komen.org

http://www.cancer.gov

Important Dates

OCTOBER
•National Breast Cancer Awareness Month

NOVEMBER
•National Lung Cancer Awareness Month

JUNE 2011
•June 4: The Hunt! A C101 Fundraiser. Save the date!

Monica Knoll’s Upcoming Speaking Engagements

The Pastures Retreat Weekend Workshop and Walk for Breast Cancer
October 22-24, 2010
Southfield, MA
The Berkshires
(space is limited)
www.thepastures.org

Fan us on Facebook: www.facebook.com/CANCER101

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Tell your friends to do the same! Like we said, we are trying to catch up and need your help to spread the word.

Contributors

Executive Director/Founder
Monica Knoll

Creative Director
Greg Betza
gbetza@optonline.net

Contributing Writers

Aracely T. Delgado
Program Coordinator, C101

Sarah Krüg
Board of Directors
C101 Steering Committee
The viewpoints expressed by Ms. Krüg in this newsletter are her own and do not necessarily represent those of her employer, Pfizer.