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430_ueno.jpgWhen doctors diagnose breast cancer, they look for three types of receptors -- estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2) -- expressed in the breast cancer. These are what cause most breast cancers to grow. They're also what our doctors typically target when treating breast cancer.

But some breast cancer patients lack these receptors. When this happens, the breast cancer is called triple-negative. And, without any receptors, it can be more challenging to treat. This is why triple-negative breast cancer (TNBC) is one of the cancers we're focusing on as part of our Moon Shots Program to dramatically reduce cancer deaths.

We recently spoke with Naoto T. Ueno, M.D., Ph.D., section chief of Translational Breast Cancer Research in Breast Medical Oncology, to better understand TNBC. Here's what he had to say.

Are some people more likely to develop TNBC?
TNBC affects women and men of all races and ages. Compared to other types of breast cancer, we tend to see this disease more in premenopausal women than older women. We're still trying to understand why these groups are more likely to develop TNBC.

Triple-negative patients are more likely to have a BRCA1 or BRCA2 gene mutation compared to non-TNBC patients. But you can still develop TNBC even if you don't have the BRCA1 or BRCA2 mutation. We're still trying to understand the link between TNBC and BRCA.

Therese_Bevers415.jpgBy Brittany Cordeiro

Recent news headlines suggest women with dense breast tissue need specialty care and exams to detect breast cancer.

But Therese Bevers, M.D., medical director of MD Anderson's Lyda Hill Cancer Prevention Center, says the news is ahead of the science.

"We understand that dense breast tissue is associated with an increased risk for breast cancer, but we don't fully understand that risk," Bevers says. "We need more research on how to manage women with dense breast tissue before we can say whether extra screening exams make a difference."  

Below, Bevers answers some common questions about dense breasts and screenings. 

What does it mean to have dense breasts?
Breast density describes the proportion of the different tissues that make up a woman's breast. Women with dense breasts have more glandular tissue (breast and connective tissue) than fat.

Also, breast density can only be determined by a mammogram. It's not a measure of feel, such as size or firmness.

amanda42.jpgBy Amanda Woodward

As a melanoma survivor, I know how important it is to find the right dermatologist. After all, I've spent my fair share of time doing just that. My husband is in the Army, and we move often. Each time, I have to find a new dermatologist. It is one of the most stressful parts of moving around for me. It takes a while to build mutual trust.

But I've been fortunate to find some really great dermatologists who listen to my concerns and whom I trust to find any abnormal moles that could lead to skin cancer recurrence.

Here's what I look for in dermatologists:

Are they listening to me?
Like really listening. I spotted the abnormal mole that led to my original melanoma diagnosis. It was just a gut feeling. No, I'm not a doctor, but I do know my body and expect my dermatologist to at least listen and acknowledge my questions and concerns. In the same breath, however, I need my dermatologist to hear me when I say I'm anxious. I would have them remove all of my skin if that were a possibility! So, I also need my dermatologist to reign me in and help me determine what really needs to be examined or removed.

Cancer_Detection_202.jpgBy Angela Young

When Samuel Loftin's blood work showed an unusual level of liver enzymes,  a gastroenterologist near his Alabama home recommended an ultrasound of his liver. When that test was negative, the doctor ordered an MRI, which showed two suspicious liver lesions, as well as an abnormality in his spine. Samuel's doctor said it was probably cancer and that spots on his spine meant it might have spread to his vertebrae. Samuel was referred to a nearby cancer center.

"My doctor set up the appointment, but it was three weeks away. I just couldn't wait that long," Samuel says.

He called MD Anderson and got an appointment right away at the Mary Ann Weiser Suspicion of Cancer Clinic. Created in 2001, the clinic is named for a former MD Anderson doctor who wanted to focus on detecting cancer at its earliest stages. Weiser always was looking for a challenge, according to colleagues.

"When patients try to come here without a clear diagnosis, it can be difficult for them to come in the front door," says John Patlan, M.D., in General Internal Medicine. "Dr. Weiser's goal was to make it easier for them."

After Weiser died in 2006, Patlan took over leadership of the clinic. Two years ago, the clinic received additional funding, and now it has a dedicated workspace in the Internal Medicine Center and a second doctor, Michael Perdon, M.D., in General Internal Medicine.


Patlan works in the clinic three days a week, and Perdon takes over on the other two days. Veronica Smith, a nurse practitioner, works full-time, and Maura Polansky, a physician assistant, works in the clinic one morning a week. Together, the team sees 15 to 20 concerned, but hopeful, new patients each week.

Patlan estimates they spend three or four hours with each patient beyond the initial one-hour clinic visit. That includes coordination of multiple diagnostic studies and phone calls to the patient and to other doctors.

Next-day appointments for Houston patients
Often, patients who live in the Houston area are surprised they can get an appointment at the Suspicion of Cancer Clinic the day after they call. When they arrive for their first appointment, Smith, the nurse practitioner  is usually the first provider they see, and they share their fears with her.

"Dealing with the unknown causes them so much anxiety," Smith says. "Some patients say they feel better even if they find out they do have cancer."

AmandaWoodward26.jpgBy Amanda Woodward

Pregnancy can do some crazy things to your, well ... everything! In my case, with both my first and now second pregnancies, my skin has broken out like I'm a teenager! But as a melanoma survivor, I know I need to pay extra attention to my skin when I'm pregnant -- and not just to the breakouts. 

Over the years, I've come to learn a thing or two about protecting yourself, and I think it is my duty as a survivor to spread a tiny bit of awareness. Here's what I've learned about caring for your skin when you're a pregnant cancer survivor: 

Communicate with your oncologist.

Prior to trying to conceive, my husband, Kyle, and I sat down with my oncologist and did a little family planning. (Romantic, right?) I completed melanoma treatment five years ago, but still attend follow-up appointments, and, of course, skin checks. We told my oncologist that we were thinking of starting a family and wanted to know what that would mean for my cancer care. He told us that as far as my cancer was concerned, there was no reason I couldn't or shouldn't become pregnant.

pathology_group_163_Edited.jpgBy Carol Bryce

It's not unusual for a patient to arrive at MD Anderson with one diagnosis and leave with a different one.

For example, when approximately 2,700 patient cases were reviewed during September 2011, 25% showed discrepancies between the original pathologists' reports and our pathologists' reports. While the changes in diagnosis were minor in 18.7%, in the other 6.2%, the diagnosis change made a major difference.

"In some of those cases, we changed the diagnosis from malignant to benign or vice versa," explains Lavinia Middleton, M.D., professor in Pathology. "That adds up to approximately 2,000 cases per year where we can say that our pathologists' reviews have impacted patients' treatment.

"Changing the diagnosis from malignant to benign is the best call to make. This makes us feel really good."

"Review of outside material is a major component of the work done by our Pathology and Hematopathology departments," adds Stanley Hamilton, M.D., division head in Pathology/Laboratory Medicine. "The correct pathologic diagnosis and stage of each tumor are key to high quality care for patients."

How we make the correct diagnosis
So why do we find things overlooked by other health care institutions?

"Our system here helps us make the right cancer diagnosis. It's based on three things: sub-specialization, volume and redundancy," Middleton explains.

A monstrous art project. A groundbreaking lung cancer screening trial. Inspiring stories from our patients and caregivers. Our mission to end cancer. These are just a few of the topics that been popular on MD Anderson's YouTube channel in 2014.

To find out what you missed -- or rediscover some favorites -- check out our top five videos from 2014.

What drives MD Anderson to end cancer

What if we could end cancer? This is the bold idea that guides everything we do here at MD Anderson. Watch our patients, survivors, volunteers and employees describe the hope they feel here and share why they believe MD Anderson is the best place to treat and ultimately end cancer:



Conquest Garden photos (1).JPGFrom the gardens to the skybridge to our leading doctors and kind volunteers, there are many things that set MD Anderson apart and help our patients feel at home. 

Whether it's your first appointment or you've become an old pro, you're likely to appreciate these 17 unique features.

1. Our 69 aquariums. The 66 freshwater and three saltwater live coral reef aquariums in our clinics are home to 3,000 fish -- mostly cichlids, angelfish and rainbow fish. The largest freshwater aquarium, by the Pharmacy in the Main Building, holds 850 gallons.

2. The Observation Deck.
Located on the 24th Floor of the Main Building, the Observation Deck offers peace and quiet, as well as a scenic view of Houston. You're also welcome to play the piano up there.

3. Our volunteers. MD Anderson is fortunate to have more than 1,200 volunteers who contributed  193,921 hours of service last year. Stop by our Hospitality Centers for a cup of coffee and to visit with these caring individuals, many of whom are survivors or caregivers themselves.

4. Our pianos. Twenty-five of our volunteers play the piano in The Park and the Mays Clinic between 10 a.m. and 5 p.m. Mondays through Fridays. They also play at the Rotary House each day. If you're lucky, you may hear our harpist or one of our two flautists as well.

5. Room service. Inpatients -- as well as their families, caregivers and friends -- can order whatever they want from room service each day from 6:30 a.m. to 9:30 p.m. Our classically trained senior executive chef comes up with the menu of fresh, cooked-to-order meals.  

erikalewis325.jpgBy Erika Archer Lewis

Twenty years ago, while a college senior, I spent weekends commuting from Austin to Houston to care for my 42-year-old mother. She was battling an aggressive form of stage 4 breast cancer and was told her odds for survival were less than 20%. After witnessing first-hand her intense, four-year battle that included chemotherapy, radiation, bone marrow extraction, a mastectomy and breast reconstruction, I wondered for years if and when breast cancer might strike me.

A family history of breast cancer
When my young, healthy, active mother was diagnosed with breast cancer, there was no pattern of women with breast cancer in her family history. But shortly after she was diagnosed, her cousin was diagnosed with the same cancer, even in the same breast. Since that time, there have been four other women on my maternal grandmother's side of the family who have struggled with or lost their lives to breast cancer.

In late 2013, after a series of suspicious mammograms, ultrasounds, an MRI, and three biopsies, I wondered if I was doomed by the pattern within my family that had reared its ugly head decades before. With recent advances in technology and medicine, I learned there was a simple blood test for identifying genetic mutations for breast and ovarian cancer, BRCA 1 and 2. I felt an overwhelming need to know if I had what felt like a ticking time bomb inside my chest.

bresalier.jpg

By Robert Bresalier, M.D.

Colorectal cancer is the third most common cancer in both men and women in the United States, and the third leading cause of cancer death.

Colorectal cancer develops in the colon or rectum, and grows slowly. In 2014, there will be an estimated 141,000 new colorectal cancer cases in the United States and 49,000 related deaths.  But colorectal cancer is preventable and curable when detected early.

Here are my top four tips to help lower your risks for colorectal cancer:

Tip 1: Get screened for colorectal cancer
Screening remains the most important method to prevent colorectal cancer. People at average risk, age 50 and older, should get a colonoscopy every 10 years. A colonoscopy enables your doctor to detect potentially cancer-causing lesions or polyps early, and remove them.

By Katrina Burton

MD Anderson is standing by a recommendation that women 40 years old and older receive annual mammograms, despite a recent study that raised controversy regarding breast cancer screening.

"We are not recommending that women change their screening practices," says Therese Bevers, M.D., medical director of MD Anderson's Cancer Prevention Center. "We stand by our guidelines that recommend women have annual mammograms beginning at age 40 and continue to be screened as long as they are in good health."

But a study by the Canadian National Breast Screening says annual mammography in women ages 40-59 does not reduce mortality from breast cancer and mammography screening should be revisited.

The results of the study, published in the BMJ Journal on Feb. 11, are in direct contrast to the U.S. Preventive Services Task Force recommendation that  women should begin annual mammograms starting at age 50, and of guidelines by MD Anderson, the American Cancer Society and others that call for annual breast cancer screening to begin at age 40.

arnold1.30.jpg

For Terry Arnold, the decision to undergo genetic testing was simple. A triple-negative inflammatory breast cancer survivor, she wanted her children to have the warning she never had.

"By having this testing I'm protecting my family," Terry says. "Now, we have the smoke alarm."

Terry is a mother of five -- three girls and two boys -- ranging in ages from 19 to 31, and a grandmother of five. Genetic testing for the BRCA gene could let those future generations know if they are at risk for breast and ovarian cancers. 

She received the results in November 2013.

"Mutated gene 5385insc-BRCA 1," the report said. That meant her children could have the gene as well.

Facing new questions after genetic testing
Terry's daughters plan to undergo genetic testing soon. Her sons are considering testing to see if they carry the gene. 

At 24-years-old, Terry's daughter Veronica says her mom's results have inspired her to schedule mammograms and cancer screenings.

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