2015 think pink - gnv 10/4/15

thinkThe Gainesville Sun Sunday, October 4, 2015

BREAST CANCER AWARENESS MONTH

‘There is not one magic bullet’

UF researchers tailor therapy to patients

PAGE 2

■ EXPANDING TREATMENTNorth Florida Regional Medical Center builds more ‘seamless’ services | 12

■ MAKING STRIDESThe annual walk to boost breast cancer awareness is expected to draw even more people this year. | 10

2 Sunday, October 4, 2015 |

By Jeff Schweers Staff writer

There are as many dif-ferent types of breast cancer as there are people who have the disease. It is not a one-size-fits-all disease so there is no single treatment.

I t s h e t e r o g e n e o u s nature makes developing better therapies for breast cancer all the more chal-lenging to treat, say the doctors and researchers at the University of Flor-ida dedicated to stopping a disease that claims over 40,000 lives in the U.S. each year.

“A wide range of types come through our door,” says Dr. Paul Okuni-eff, chairman of the UF Department of Radiation Oncology and director of UF Health Cancer Center.

Okunieff is bull ish about some of the emerg-ing, cutting edge research being conducted here at UF’s College of Medi-cine and Shands teaching hospital in creating per-sonalized treatment, particularly the research

being conducted at a molecular level.

UF is putting millions of dollars a year into breast

cancer research, with a broad range of laboratory and clinical studies from exploring new therapies and diagnostics to pin-pointing the exact genetic makeup of a person’s indi-vidual cancer.

“More and more, we are learning that differ-ent types of cancers don’t

come from classes them-selves,” Okunieff said, referring to the classes of squamous cells, which starts in cell linings and can lead to skin cancer, and adenocarcinomas, which start in glandular cells and cause breast cancer.

“While that is what they look l ike under

microscope, what we are looking at more and more are the specific driver genes that make it a cancer,” he said. “If you knew the driver mutations you could have targeted drugs that attack those mutations.”

Dr. Coy Heldermon, an assistant professor of

medicine and oncologist who specializes in treating breast cancer using stem cell and gene replace-ment therapies. He’s had success developing thera-pies from patient-derived xenografts — growing human tumor cells in mice.

“We put a tumor from a woman’s breast into a mouse breast,” he said.

If it succeeds in grow-ing, he and his team can transfer the same genetic material into 50 other mice and start developingtherapies designed to treat that particular patient.

However, the process takes a year to 18 months — longer sometimes than would actually help the patient, he said. “I am notoffering as a way to treat patients, but using it as a way to collaborate with people for drug discov-ery,” Heldermon said.

Once they have enough tumors, they can do clinical trials of different patients, trying differ-ent drugs on the tumors and seeing which therapy shrinks the tumor with the least side effects.

Heldermon tells his patients it’s like figur-ing out which fuels work best with which engines.

RESEARCH

One approach doesn't fi t all:

TAILORING THERAPIES

From left to right, researcher Ling Bao Ai, under graduate research assistants Alex McNally and Priya Shil, and lab manager Kelsea Grant, perform a procedure in which they will extract a human tumor grown in a mouse. They are working in the laboratory of Dr. Coy Heldermon, assistant professor of medicine at the Academic Research Building at the University of Florida. ERICA BROUGH/STAFF PHOTOGRAPHER

SEE THERAPIES ON PAGE 4

ABOUT THE COVERFlorida Gators gymnast Rachel Spicer and head coach Rhonda Faehn point into the stands at Spicer’s mother, Mickie, after competing in Link to Pink home meet against the Kentucky Wildcats in February. Mickie Spicer had been recently diagnosed with stage 3 breast cancer. Her fi ght against cancer has been successful. The Link to Pink meet, now in its ninth year, raises awareness of breast cancer issues. Staying active is one important strategy to combat breast cancer, which can be a threat even to young people. See the related story on page 9. FILE PHOTO BY MATT STARNEY

SICK OF PINK? Wonder where thepink ribbon SS goes?What: Pink Ribbons, Inc.documentary screeningWhere: UF Ustler Hall AtriumWhen: 10/15 at 6 PM

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| Sunday, October 4, 2015 3


Some work on gasoline, some on diesel and some on ethanol.

Imagine he and his col-laborators as mechanics working in a giant garage. But instead of figuring out how to make engines run, they are trying to find the best way to shut them down.

“ T h e y a r e t e s t i n g whether that inhibitor will block that engine in the cells of the tumor,” Heldermon said.

Heldermon has collab-orations with many other researchers at UF. One collaboration in particu-lar is with Brian Law, a pharmacologist studying a particular cell pathway called CDCP1, a protein that is a driver for cancer cell mutation.

Law has developed an inhibitor for that protein that Heldermon is testing on different xenografts in various combinations to see what works most effec-tively. Two of the major unmet needs in breast cancer treatment have been the inability to treat meta-static disease and to combat drug resistance, Law said.

“ T u m o r s i n i t i a l l y respond then become resistant to the drugs,” Law said. “Once that happens there are limited options going forward.”

He’s working on break-ing the code on the CDCP1 protein to figure out how to stop it from causing cancer to spread — metas-tasize — throughout the other organs in the body.

Using tumor cells of a patient grown inside a mouse helps them hone in on the genetic differences that cause cancer and differ from patient to patient.

“There is not one magic

bullet that can cure all cancer,” Law said. “We n e e d t o p e r s o n a l i z e medicine,” which means understand the mecha-nisms driving the cancer.

UF researchers are also trying to break the code on a particular type of breast cancer that has mystified physicians. It’s called triple-nega-tive cancer because it is defined by what it lacks rather that what causes it.

“When you describe something by what it is not,

you don’t know what it is,” said Karen Daily, a clinical based investigator at UF.

Daily belongs to a coop-erative of scientists at other institutes conduct-ing trials on patients with triple-negative cancer whose initial chemother-apy and surgery didn’t remove all the cancer.

They study the tumor to try to identify the muta-tions that lend themselves to a drug already on the shelf that may have been used in other cancer

settings and aggressively treat them following sur-gery instead of the normal follow-up routine.

“The ability to do this kind of genomic testing on tumors where we are looking at multiple genes and do it rapidly at a low cost has really just kind of exploded in last five years or so,” Daily said. “It really is an exciting time to be in oncology because there is a lot of potential to better understand cancer and have better treatment options.”

Dr. Coy Heldermon, right, works in his lab with researcher Ling Bao Ai. Heldermon is working to develop tailored therapies that draw on the patients’ own genetic material. ERICA BROUGH/STAFF PHOTOGRAPHER

The ability to do this kind of genomic testing on tumors where we are looking at multiple

genes and do it rapidly at a low cost has really just kind of exploded in last fi ve years or so. It really is an exciting time to be in oncology because there is a lot of potential to better understand cancer and have better treatment options.”Karen Daily, clinical-based investgator at the University of Florida

THERAPIESCONTINUED FROM PAGE 2

Walk together.And we’llneverwalkalone.October 24 is only the beginning.

Sign up TODAY!Making Strides Against Breast Cancer of GainesvilleDowntown Gainesville, Front of the Hippodrome | 9 a.m.MakingStridesWalk.org/GainesvilleFL

©2015 American Cancer Society, Inc.



By Melissa EricksonMore Content Now

Yoga’s rejuvenating and therapeutic effects make it a popular exer-cise regime for millions of people. For breast cancer patients and survivors, yoga not only helps con-trol physical functions like breathing, heart rate and blood pressure, it offers some surprising benefits, too.

“Yoga can improve the quality of life for breast cancer patients in several ways,” said Dr. Janice Kiecolt-Glaser, director, Institute for Behavioral Medicine Research, Ohio State University College of Medicine. Kiecolt-G l a s e r w a s t h e l e a d author of a recent study that found that yoga can lower fatigue and inflam-mation in breast cancer survivors. The women in the study were less fatigued than women not practicing yoga, and the more women in the study practiced yoga, the better their results.

“Fatigue is a really important quality of life marker for breast cancer patients because it has such a pronounced effect on daily life. The fatigue is not like being short of sleep but rather the kind of fatigue that can per-meate the day and the ability to do many daily activities,” Kiecolt-Gla-ser said.

MIND AND BODY

REMEMBER TO BREATHE

The surprising benefi ts of yoga for cancer patients, survivors

■ FATIGUE FIGHTERIt’s estimated that perhaps 30 to 40 percent of longer-term

breast cancer survivors have debilitating fatigue after treatment, Kiecolt-Glaser said. Women stressed with fatigue are often so tired that they’re less likely to exercise.

“The less they exercise, the more tired and the weaker they may be, so it’s a downward spiral. Yoga was a way of interrupt-ing that spiral and getting women the opportunity to learn a new skill that was not too physically demanding and that helped the fatigue substantially,” she said.

Sleep issues are often commonplace in breast cancer patients and survivors “much more so than their age mates in the general population who haven’t had cancer,” said Kiecolt-Glaser. Yoga can help relieve the insomnia caused by breast cancer treat-ments and medications.

■ STRESS RELIEVERFor women with breast cancer undergoing radiation therapy, a

mind-body approach to yoga offers health benefi ts beyond fi ght-ing fatigue, according to research from the University of Texas MD Anderson Cancer Center.

Women who practiced yoga exercises that incorporated controlled breathing, meditation and relaxation techniques into their treatment plan experienced improved ability to engage in daily activities, better general health and better regulation of the stress hormone cortisol. Women in the yoga group were also better equipped to fi nd meaning in the illness experience, which declined over time for women in the other groups.

“The transition from active therapy back to everyday life can be very stressful as patients no longer receive the same level of medical care and attention. Teaching patients a mind-body technique like yoga as a coping skill can make the transition less diffi cult,” said Dr. Lorenzo Cohen, professor and director of the Integrative Medicine Program at MD Anderson.

What was the important ingredient in yoga that benefi ts breast cancer patients and survivors?

“Because yoga has several different components – breathing, meditative and movement or postures – we don’t know which of those was potentially most important. We assume they were all important or that one was more important than the others,” Kiecolt-Glaser said.

■ BEFORE YOU BEGINBefore starting any new workout program, women should

check with a physician.“One of the nice things about yoga, especially a restorative

yoga like hatha yoga training, is that it is relatively low demand in terms of physical limitation,” Kiecolt-Glaser said. Check with the teacher and ask what kind of class it is and if back or other physical issues can be addressed easily in class.

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DIAGNOSTICS/TREATMENT

■ CANCER RECOVERY PROGRAM: Gainesville Health & Fitness and ReQuest Physical Therapy partner to provide a free four-week individual exercise class program offered year-round for cancer patients and survivors. To learn more, call Debbie Lee at Gaines-ville Health & Fitness at 377-4955 or the ReQuest Physical Therapy Center at 373-2116.

■ ACORN CLINIC: Provides low-income women of all ages sliding scale rates for women’s health exams including breast cancer screenings. Reduced cost mammo-grams are also available. Location: 23320 N. State Road 235, Brooker. Hours: Monday and Wednesday 8 a.m.-4 p.m and Tuesday and Thursday 8 a.m.-8 p.m. For more informa-tion, call 485-1133 or visitwww.acornclinic.org.

■ UF HEALTH SHANDS

ARTS IN MEDICINE: Programs cater to hospi-talized patients, such as visual, performing and literary arts. The Criser Cancer Resource Center provides a space away from the medical aspect of UF Health through well-ness classes, an extensive library and computers. Location: 1515 SW Archer Road, Room 1302. To learn more, visitwww.artsin-medicine.ufhealth.org or call 733-0880.

■ NORTH FLORIDA REGIONAL MEDICAL CENTER BREAST HEALTH PROGRAM: Provides patients with mammo-grams, breast ultrasounds, minimally invasive breast biopsies, treatment options and reconstruc-tion. Location: 6500 Newberry Road. 333-4000.

SUPPORT/OUTREACH

■ HEALING TOUCH CANCER SUPPORT GROUP: The spiritual group welcomes all cancer

patients, survivors, family and friends at 5:30 p.m. the third Thursday of each month, Trinity United Methodist Church, 4000 NW 53rd Ave. To learn more, call Marcey Corey at 331-2960.

■ GAINESVILLE BREAST CANCER SUP-PORT GROUP: The free monthly group welcomes breast cancer patients and survivors, and women with all forms of cancer. It meets 6-8 p.m. every third Monday of the month at Trinity United Methodist Church, 4000 NW 53rd Ave. For more information, contact Claudia Harris at 378-7212 or Sandy Snyder at 281-7499 or Debra Rowley at 386 418 4311

■ UF HEALTH BREAST CANCER SUPPORT GROUP: For all who are affected by breast cancer. Third Wednesday of the month at 6 p..m.- 7 p.m. Location: UF Health Shands Cancer Hospital, 1515 SW Archer Rd., Room 8011. For more

information contact Pamela Clevenger, at 352.265.7070 or [email protected] .edu.

■ CANCER CONNEC-TIONS: Open to all cancer survivors, patients, caregivers, and healthcare professionals. Meeting topics include nutrition, physical and emotional therapy, current research, and home care. Third Wednesday of every month from noon to 1:00 p.m. Location: UF Health-Street, 2401 SW Archer Rd For more information contact Barb Thomas at [email protected].

■ HEART OF HEALING SUPPORT GROUP: Free weekly meditation and support group for people going through cancer treatment, their friends and families and the com-munity at- large. Tuesdays noon-1p.m, North Florida Regional Medical Center Cancer Center, 6420 W. Newberry Rd. For more information contact Joanie Kniseley at 386-853-0162.

■ LOOK GOOD, FEEL BETTER CLASS: Class for women in cancer treatment. Meets the second Monday of the month from 10 a.m.-noon. Location: North Florida Regional Medical Center Cancer Center, 6420 W. Newberry Rd. Meets the third Monday of the month at the American Cancer Society Hope Lodge, 2121 SW. 16th St. To regis-ter, (800) 227-2345.

■ ROAD TO RECOVERY: American Cancer Society volunteer program that offers free transportation to and from treatment. For more information call (800) 227-2345

■ ESPECIALLY FOR WOMEN: The fi rm offers a full line of breast forms and mastectomy bras for every type of breast surgery, as well as swimwear, headwear and lymphedema sleeves. Location: 6781 W. New-berry Road, Oaks Mall Plaza. For more informa-tion, call 332-9095.

■ PAT’S PERFECT FIT: The business sells mastectomy apparel and supplies, as well as ortho-pedic soft goods, wound care supplies and aids to daily living. Location: 3501 SW Second Ave. For more information, call 377-6060.

SUPPORT GROUPS

Survivors and their loved ones have many resources

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By Chris CurryStaff writer

Five days a week for six weeks in late 2012, Kelly Jones left her assistant principal job at Fort Clarke Middle School in the late morning and traveled to Jacksonville.

There, she would lie down on a treatment table as a beam of protons accel-erated to nearly the speed of light shot radiation into the left side of her chest.

Diagnosed with breast cancer in March 2012, Jones went through sur-gery, chemotherapy and conventional radiation treatment with X-rays.

In an effort to ensure the cancer did not return, she also went to the Uni-versity of Florida Health Proton Therapy Institute

in Jacksonville for treat-ment that relied on a massive nuclear particle accelerator, a medical use of a product of some high-level physics research.

Three years later, Jones, now 41, remains cancer free.

“Everything is good so far,” she said. “That is what we hope will continue.”

Meanwhile, UF doctors in Jacksonville continue to move deliberately into the use proton therapy for some breast cancer patients.

The UF proton therapy treatment center opened in 2006 and is now one of 14 operating in the nation, with another 11 planned, according to the National Association for Proton Therapy.

Over the last decade,

the UF center has treated more than 6,000 cancer patients with proton therapy. But the center’s use of proton therapy to treat breast cancer started more recently and is not yet widespread. The breast cancer program started in 2012 and has so far treated a little more than 50 women, said Dr. Julie Bradley, a radiation oncologist at the Proton Therapy Institute.

Bradley said UF has decided to focus the proton treatments on more advanced cases of breast cancer, including cases that have spread to the lymph nodes.

Bradley said the proton therapy is more precise than traditional radiation treatments and avoids exposing healthy tissue

and organs like the heart and lungs to radiation.

“The main benefit is we can decrease the side effects,” Bradley said.

In Kelly’s case, the cancer was in the left breast and doctors used proton therapy to avoid deliver-ing a dose of radiation to the heart that could, in the long-term, lead to cardiac disease or mortality.

Right now, Bradley is leading a long-term UF clinical study on women with left breast cancer to determine if traditional radiation therapy leads to changes in heart function that women who went through proton therapy did not have.

Given the expensive price of the facilities- the UF institute was $125 million - patient cost is

one reason why proton therapy is not more widely used. Out of pocket costs can be “extremely high,” Bradley said and “insurance barriers are significant.”A National Public Radio report from last year said proton therapy can be three to six times conventional treatments and many insurers do not cover the treatments. do not costs can sometimes run three to six times higher than conventional treatments and many insurers do not cover proton therapy.

Kelly said the treatment would have been beyond her means if the costs were not covered because she was part of the clini-cal trial.

“ I t w a s w o r t h t h e drive,” she said.

UF HEALTH

Doctors delve into proton therapy treatment for breast cancer

UF Health Proton Therapy Institute in Jacksonville has three treatment rooms equipped with 360-degree rotating gantries to deliver proton therapy from any angle. PHOTO COURTESY OF

RYAN KETTERMA

FACTS&FIGURES2006: The year the UF

proton therapy treatment center opened

14: Number of treatment centers

operating nationwide

11: Number of treatment centers planned to open

6,000: Cancer patients treated with proton therapy at center

2012: Year the breast cancer proton therapy

program started

50: Number of patients breast cancer program

has treated



Cara Scharf’s journey with breast cancer began when she was young. She was diagnosed with stage 1c breast cancer with a 2 cm tumor when she was just 25 years old — but really it began even earlier than that.

“My mom passed away from breast cancer when I was 3. She was fairly young, in her 40s. Her mother died early, too, from ovarian cancer, so I knew I had a strong family history of breast cancer, but I didn’t know what that meant for me,” said the Philadelphia 30-year-old.

Breast cancer wasn’t dis-cussed frequently in Scharf’s home growing up, but when Cara was 22 her father, an obstetrician/gynecologist, talked with her about the BRCA1 and 2 gene mutations that lead to a higher risk of developing the disease. She considered it a smart move to get tested.

S h e t e s t e d p o s i t i v e f o r BRCA1.

“I always knew that there was

a high likelihood that I could develop breast cancer, but the test results made it more formal. I had a piece of paper that showed I have a high risk of breast and ovarian cancer,” said Scharf, who is also an Ashkenazi Jew, a population with a higher incidence of breast cancer.

At 22, during the summer after she graduated from college, Scharf opted for no treatments or surgery.

“I just felt I was too young,” she said.

At 25, her annual mammogram looked normal with no signifi-cant findings. Six months later, a follow-up MRI looked suspicious. Next came an ultrasound and a biopsy and then the diagnosis.

After the ordeals of surger-ies and treatment from May through December 2011, Scharf is now healthy and sharing her story through the CDC’s new Bring Your Brave campaign.

“I’m all about telling people my story. Knowing I had the BRCA gene saved my life. If I hadn’t started screening early, I don’t know if I’d be alive

today,” she said. Caught later, the cancer “might have been at a much higher stage or may have spread to other parts of my body,” Scharf said.

SPECIAL CHALLENGES“While rare, 11 percent of all

cases of breast cancer in the United States are reported in women under 45 and many of them may not realize they’re at risk,” said Dr. Temeika Fairley, health sci-entist with the CDC’s Division of Cancer Prevention and Control.

W o m e n d i a g n o s e d a t a y o u n g e r a g e f a c e u n i q u e challenges. They’re in their reproductive prime and may be looking to have children or have children to care for. Breast cancer may be inter-rupting work or school and impact a woman financially. There are also issues with body image and relationships, Fair-ley said.

Breast cancer in young women is:

• More likely to be heredi-tary than breast cancer in older women.

• More likely to be found at a later stage.

• Often more aggressive and difficult to treat.

All women are at risk for breast cancer, but some things can raise a woman’s risk for getting breast cancer before age 45. Learn-ing what factors increase your chance is an important first step in assessing your risk. Learning the symptoms of breast cancer also may help you know when to talk to your doctor.

‘KNOW YOUR NORMAL’Because breast cancer at a

young age is so uncommon, “you feel like you’re the only person you know who’s going through it. You’re thrown into a situation that’s so hard and isolating,” Scharf said.

It may not feel like it, but sup-port is out there.

“You’re not alone. Connect with people,” said Scharf, who blogs about her experi-ence at Wearing My BRCA Genes, https://youngbrca1.wordpress.com. She started a cancer connection group

that sponsors meet-ups and joined other groups to make connections for social rea-sons and to learn from others’ experiences.

The goal of the Bring Your Brave campaign, which shares stories about young women affected by breast cancer, is to inspire women to learn about their risk for breast cancer and to encourage them to live a breast-healthy lifestyle.

“Know your body and the warning signs of breast cancer,” Scharf said. “Know your normal. If something feels weird or out of place, be an advocate for your-self to get the care and attention that you need, even if you’re not a considered a high risk.”

For more information about Bring Your Brave and breast cancer in young women, visit www.cdc.gov/BringYour-Brave. Join the conversation using #BringYourBrave and b y f o l l o w i n g C D C B r e a s t Cancer on Facebook; CDC’s Breast Cancer board on Pin-terest, and @CDC_Cancer on Twitter.

CANCER UNDER 45

YOUTH MOVEMENTSupport exists for cancer patients younger than 45


By Kelsey SanchezCorrespondent

Thousands of people are expected to turn out on Oct. 24 to help boost breast cancer awareness and raise money to help

fight breast cancer, local organizers say.

The annual Making Strides Against Breast Cancer 5-K walk will begin at 9 a.m. in front of the Hippodrome The-atre at 25 SE Second Place

in Gainesville. The local event is one of nearly 300 Making Strides Against B r e a s t C a n c e r w a l k s being held around the nation.

The American Cancer Society event is all vol-unteer driven and sponsor supported, and event coordinator Jessica Clay-ton said it is growing in popularity.

“Last year we expected 3,000 people and had around 3,200,’’ she said. “The event is growing,

next year we might need to expand to a bigger location.’’

At least 106 teams with 384 members have regis-tered for the event, with a goal of having 195 teams registered.

Participants raised $160,000 last year, and Clayton said this year’s goal is $165,000.

Survivors and past teams are brought back for the annual walk. “It’s a very powerful event,” Clayton said.

Many involved in the event have a personal connection to breast cancer, whether they know someone who has it, or knows someone who has died from or survived cancer. But Clayton says not everyone who comes to the walk has a per-sonal connection, there are those who are simply t o u c h e d b y p e o p l e ’ s stories, or the event in general.

“It’s awesome to see all of the work come

together,” she said, “so many women are being supported by their family, co-workers, friends, and loved ones.”

For more information, and to hear about survi-vors and to read personal testimonies about the impact breast cancer has had on lives, visit http://main.acsev-ents.org/site/TR/MakingStridesAgain-stBreastCancer/MSABCCY15FL?pg=entry&fr_id=70031.

Thousands set to walk and raise funds to battle breast cancer

Craig Wyatt, left, and Cecil Howard take off at the start of the American Cancer Society’s Making Strides Against Breast Cancer walk in October 2013 in Gainesville, Fla. Hundreds of local breast cancer survivors, volunteers, businesses and community members walked or ran in the noncompetitive event to raise money and awareness to help end breast cancer. FILE PHOTO BY MATT STAMEY

MAKING STRIDES AGAINST BREAST CANCER

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Having trouble sleeping through the night makes it hard to function during the day and is a public health epidemic, according to the Centers for Disease Con-trol and Prevention. Breast cancer patients are part of the estimated 50 million to 70 million people affected by sleep disorders.

Insomnia is a common side effect of medical treatments and medica-tions aimed at saving their lives. According to Breast-Cancer.org, insomnia can be caused by treatments Ixempra (chemical name: ixabepilone), a chemo-therapy medicine; Tykerb (chemical name: lapa-tinib), a targeted therapy; and hormonal therapies Arimidex (chemical name: anastrozole), Aroma-s i n ( c h e m i c a l n a m e : exemestane) and Faslo-dex (chemical name: fulvestrant). Some pain medications also can cause sleeping problems.

What is insomnia?Different than just trou-

ble sleeping, “insomnia occurs when you have trouble falling asleep or staying asleep even though you had the opportunity to get a full night of sleep. One night of poor sleep is not necessarily insom-nia; occasionally almost everyone has trouble sleeping,” said Rosen, who is the program direc-tor for the University of Pennsylvania Sleep Fel-lowship and an associate professor of clinical medi-cine for the University of

Pennsylvania School of Medicine in Philadelphia.

Insomnia can occur after a stressor or major life change – such as being diagnosed with breast cancer – but it’s when sleepless nights start turning into sleepless weeks that it’s time to start think-ing about insomnia. There are two types, short-term and chronic. Short-term insomnia lasts less than three months – this occurs in 15 to 20 percent of indi-viduals. Chronic insomnia, which occurs at least three times a week for at least three months, occurs in 10 percent of the population, Rosen said.

Insomnia affects your mood and energy, leaves you feeling fatigued and makes it hard to concen-trate, said sleep expert Dr. Ilene Rosen, who serves on the board of directors for the American Academy of Sleep Medicine.

If you are having trou-ble sleeping, the first step is to make sure you are employing good sleep hygiene, Rosen said. Here are some of her tips for overcoming insomnia:

• Keep a regular sleep schedule, making sure to go to bed when you are sleepy and wake up at the same time every morning – even on the weekends.

• Make sure your bed-room is quiet, dark and a little bit cool – it should remind you of a cave.

• Avoid caffeine in the afternoon as this can keep you awake at night.

• No screens for at least an hour before bedtime or in the bedroom. That means no TV, no phones, no tablets. The blue light

they emit can hinder mel-atonin production, which is what makes you sleepy.

• Feel the need for a nap? Limit yourself to no longer than 10-20 minutes in the early afternoon when you feel a natural increase in sleepiness, Rosen said. “Naps of 30 minutes or longer may cause groggi-ness or ‘sleep inertia,’ and it can delay the performance benefits of a nap,” she said.

“Sleep, exercise and nutrition are three pillars for a healthy lifestyle. A recent survey found that individuals reported sleep-ing better if they exercised regularly. Research has found that exercise before bed may be OK – how-ever, those suffering from insomnia should avoid vig-orous activity in the hours immediately before bed-time,” Rosen said.

More adviceStill awake after 20

minutes? “Get out of bed. Don’t lie there tossing and turning in frustration. Sit and read quietly (but not in any bright light) and crawl back into bed when you are sleepy,” Rosen said.

Avoid heavy meals, caffeinated drinks and alcohol shortly before bed.

“Our daily routines – what we eat and drink, how and when we exercise, the drugs and medicines we consume, how we schedule our days – can significantly affect the amount and the quality of the sleep we get,” Rosen said.

If your sleep is suffer-ing, see a specialist at an accredited sleep center – you can find one at sleepeducation.org.

SLEEP

Up all nightMeds making it hard to sleep?

Try these tips


By Christopher CurryStaff writer

A 25,000-square-foot, $10 million building now under construction at North Florida Regional Medical Center has hospital officials talking about more coordinated, comprehensive and seam-less services to treat cancer, including breast cancer.

When completed in late spring 2016, the new Florida Cancer Specialists and Research Institute building will be attached to North Florida Regional Cancer Center, bringing surgeons, medical oncologists from Florida Cancer Specialists and radiation oncologists from the Cancer Center all within a matter of feet from one another, ben-efiting doctors and the patients going through difficult, energy-sapping treatment, said said Dr. Allison Grow

a radiation oncologist at North FloridaRegional at the Cancer Center.

“It will be a comprehensive cancercenter,” Grow said. “Florida CancerSpecialists will be 20 feet from us. Thedoors are literally going to open from ourlobby.”

Mammography, nutrition, massageand physical therapy services will also betied more closely together, Grow added.

The new building will be nearly doublethe size of the existing Florida CancerSpecialists building in Gainesville.

In a March statement when groundbroke on the new building, Dr. WilliamHarwin, the founder and president ofFCS, noted that the “healthcare industryis placing more emphasis on a patient-centric delivery model that includeshigher quality and better located facili-ties” and the new Gainesville facilityfollowed that model.

UNDER CONSTRUCTION

North Florida Regional offi cials: New building will more closely tie cancer care

Cancer patient Dawn Delaney rings the bell that signals the end of her treatment at the Cancer Center at North Florida Regional Healthcare. FILE PHOTO BY ERICA BROUGH

“It will be a comprehensive cancer center. Florida Cancer Specialists will be 20 feet from us. The doors are literally going to open from our lobby.”Dr. Allison Grow


OUR FAMILY OF DOCTORS AND MIDWIVESTracey Botha, M.D. • Richard A. Brazzel, M.D. • Kelly Chamberlain, M.D. • Sheyna Carroccio, M.D. • Jill Roscoe Delker, M.D.

Karen E. Harris, M.D. • Ann Hatfield, M.D. • Eduardo Marichal, M.D. • Amy Million, M.D. • Erin Connor Werner, M.D.Julie Gaona, CNM • Amanda Husband, CNM • Monique McAfee, CNM • Erin Smith, CNM

In honor of Breast Cancer Awareness Month, NorthFlorida Women’s Physicians proudly encourages you toschedule your annual mammogram. We truly believe

that early detection saves lives.We will refer you to the best mammographers in thearea to help handle your breast health concerns.

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Building healthy relationships.



Intensely studied for more than a decade, the BRCA1 and 2 genes are known to be huge risk fac-tors for developing breast cancer. But what

have you heard

a b o u t t h e n e w e r a n d

less well-known PALB2 gene? Is

it something you should be asking your doctor about?

“About 10 per-c e n t o f b r e a s t

cancers are felt to be hereditary,” passed from parent to child, and “caused by mutations in genes,” said Dr. Marleen

Meyers, oncologist and director of the survivor-ship program at New York University’s Perlmut-ter Cancer Center. “The most commonly discussed genes in breast cancer are BRCA1 and BRCA2. More recently, a mutation in another gene, PALB2, that works closely with the BRCA genes to repair DNA damage in cells was found to increase breast cancer risk and has been found in up to 4 percent of families with a history of breast cancer.”

RECENT DISCOVERIESResearch from the Uni-

versity of Cambridge found that mutations in the PALB2 gene predispose women to breast cancer, but the effect

of the mutation on the prognosis of cancer is still being studied. The PALB2 gene was identified in 2006 and linked to breast cancer in 2007.

In 2014 a study led by University of Cambridge researchers found that the PALB2 gene increases the risk of breast cancer to 1 in 3 by age 70. Since BRCA1 and 2 were discovered, no other genes of similar importance have been found, said study author Dr. Marc Tischkowitz, who compared PALB2 to a possible “BRCA3.”

How the gene PALB2 reacts with the BRCA1 and 2 genes is of great interest to the medical community.

“One important study

looked at people who had an abnormal PALB2 gene but normal BRCA1 and 2 genes,” Meyers said. “These women had a 14 percent risk of developing breast cancer by age 50 and a 35 percent risk of develop-ing breast cancer by age 70.

“Looked at another way, a woman by age 70, with an abnormal PALB2 gene who had no family history of breast cancer, had a 33 percent risk of developing breast cancer. And, if two or more first-degree rela-tives had breast cancer, the risk increased to 58 per-cent,” Meyers said.

SHOULD I BE TESTED?Researchers continue

to study the PALB2 gene, which makes a protein that interacts with the protein made by the BRCA2 gene, and whether it increases the risk for other forms of cancer.

“Investigators have found an association between PALB2 muta-tions and ovarian cancer, male breast cancer and pancreatic cancer, but the significance and lifetime risks need further assess-ment,” Meyers said.

If you have red flags in your medical chart — a strong family history of breast cancer with nega-tive testing for BRCA1 and 2, you may want to con-sult with a doctor about PALB2, Meyers said. For most women, though, it’s not a reason to rush to the doctor for genetic testing.

Unlike BRCA muta-tions, there are no national guidelines for testing of PALB2 or for management of breast cancer in women who carry the PALB2 gene, Meyers said.

GENETIC RESEARCH

PALB2: Gene mutation may be a new cancer indicatorBy Melissa EricksoMore Content Now

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O B S T E T R I C S • M I D W I F E R Y • G Y N E C O L O G Y

6400 West Newberry Rd., Suite 207 • GainesvilleMedical Arts Building ~ next to NFRMC

352.371.2011 • www.GvilleOBGYN.com

Michael Cotter, MD • David Stewart, MD • Ashley Walsh, MD • Ronnie Jo Stringer, ARNP, CNM • Cynthia Vista, ARNP, CNM • Padi Sutherland, ARNP, CNM

We deliver more than expected.

The best protectionis early detection.

GrowingAwarenesstoSaveLives

As we recognize Breast Cancer Awareness Month, weremember the women who have lost their lives to the disease,and we voice our support for those in the fight of their lives.


Keeping in shape, inside and outBy Melissa EricksonMore Content Now

Lifestyle choices absolutely make an impact in breast cancer. In addition to regular health exams with a doctor, there are plenty of things a woman can do to control her breast health.

● EXERCISE REGULARLY: “Regular exer-cise and healthy diet are associated with reduced risk of developing breast cancer and can also reduce the risk of developing a breast cancer recurrence,” said Dr. Rachel Layman, a breast oncol-ogist with the Ohio State University

Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Colum-bus, Ohio. The recommendation is for patients to have at least 30 minutes of moderate to vigorous exercise at least fi ve days a week.

● MAINTAIN A HEALTHY WEIGHT: “Although we don’t know for sure why exercise helps, it is likely related to a variety of factors, such as maintaining a healthy weight in addition to hormonal factors such as effects on estrogen and insulin,” Layman said.

● EAT RIGHT: There is no specifi c food

that will keep cancer away, but the best diet to lower the risk of cancer is one that is low in fat, high in fruits and vegetables and with limited red and processed meats. “Your diet should allow you to maintain a healthy weight,” said Dr. Joan Kramer, Winship Cancer Institute of Emory University breast cancer expert.

● WATCH YOUR DRINKING: “Alcohol does increase the risk of breast cancer, and in terms of breast cancer risk the less you drink, the better, since even as little as one alcoholic drink a day is linked to a small increase in risk,” Kramer said.

● KNOW YOUR HISTORY: “Although women with a family history have an increased risk of breast cancer, only 15 percent of women with breast cancer have a family history of the disease. Some women think that they won’t get breast cancer because it doesn’t run in their family, but that isn’t true,” Kramer said.

● GET CHECKED: “Most women should have an annual mammogram and clini-cal breast exam once per year starting at age 40, although recommendations can differ based on individual risk fac-tors,” Layman said.


Is your doctor keeping a secret from you?

I f y o u d o n ’ t k n o w y o u r b r e a s t d e n s i t y , you don’t have all the knowledge you need to make informed deci-sions about your breast health, said Nancy Cap-pello, a former education a d m i n i s t r a t o r f r o m Woodbury, Connecticut, who started the Are You Dense campaign to edu-cate other women.

Cappello calls breast density “a best-kept s e c r e t . ” I f y o u h a v e a m a m m o g r a m , y o u r d o c t o r k n o w s y o u r breast density, but is he sharing this critical information with you? D e p e n d i n g o n w h i c h state you live in, the answer could be no.

NANCY’S STORYCappello’s story is

shocking. After more than a decade of routine annual mammograms and the “happy gram” reports that showed her results as normal with no signifi-cant findings, Cappello was told she had cancer when a doctor noticed a suspicious ridge in her right breast during an annual physical exam. A subsequent mammogram revealed nothing, but an ultrasound showed stage 3c cancer that had spread to 13 lymph nodes.

“From the size and how it metastasized, the cancer had been growing for six years,” Cappello said.

As a healthy woman and educated patient who watched her weight, exer-cised regularly and never missed a mammogram appointment, Cappello

was bowled over to learn she had advanced breast cancer. That’s when her doctor told her about her dense breast tissue and how it can hide cancer on a mammogram.

“I asked, ‘Why wasn’t I told I have dense breast tissue?’ The response was that it’s not stan-dard protocol to share the information with the patient,” Cappello said. She went into action, and Connecticut was the first state to pass a breast den-sity notification law.WHAT DOES ‘DENSE’ MEAN?

“Dense breast tissue is not abnormal. It’s just the way a woman is built,” said Dr. Kathryn Evers, director of breast imag-ing at Fox Chase Cancer Center in Philadelphia. About 50 percent of the population has dense b r e a s t t i s s u e , w h i c h

means that it has a high proportion of glandular or connective tissue.

“A radiologist reads a mammogram and rates it in four different cat-egories from extremely fatty to extremely dense,” said Dr. Emily F. Conant, professor and chief, Divi-sion of Breast Imaging, Department of Radiology, Hospital of the University of Pennsylvania. Ten per-cent of people have entirely fatty breast tissue and 10 percent have extremely dense breast tissue. The other 80 percent of the population is broken down evenly between scattered fibroglandular (fatty) tissue and heterogeneously dense.

Dense breast tissue camouflages tumors on a mammogram, Evers said. Fatty tissue shows up greyish black on a

mammogram, making it stand out. Dense tissue looks white. Breast masses or tumors also appear white on a mammogram, making them hard or impossible to spot in dense breasts.

“Breast density varies by age and weight,” Conant said. As women age their breasts become less dense. Women who are overweight or obese often have denser breasts.

Not only can dense

breast tissue hide cancer on a mammogram, “thereis some increased risk for breast cancer for women with dense breasts,” Evers said.

It’s not possible to tell if your breasts are dense by sight or feel.

“It’s not a matter of a breast feeling firm or lumpy,” Evers said. “Breast density can only be determined by a mam-mogram,” she said.

BREAST DENSITY

ARE YOU DENSE?Cancer survivor creates campaign to inform women about breast density

FAYE MCKNIGHT386-758-7779363 SW BAYA DR STE 102LAKE [email protected]

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Mammogramssave lives.Scheduleyourstoday.

Conveniently located in northwest Gainesville, UF HealthWomen’s and Diagnostic Imaging – Springhill isthe first American College of Radiology-accredited Breast Imaging Center of Excellence in North CentralFlorida. Our caring staff and board-certified UF Health radiologists provide advanced diagnostics, includingbreast ultrasound, stereotactic breast biopsy and 3-D digital mammography.

For an appointment, call 352.265.0000 or visit UFHealth.org/mammography.

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