12 Weeks is a Long Time to Wait for Breast Cancer Chemotherapy

FIRST PERSON | How long a wait is too long when it comes to treatment of breast cancer? A report published in the Dec. 19 issue of JNCI, Journal of the National Cancer Institute, states that after examining records from 6,622 women, the average time for a woman to wait for adjuvant chemotherapy (chemo given after surgery) for breast cancer is 12 weeks. After my surgery, I waited four weeks before chemotherapy began.

Reconstruction delays

A main cause for delays in starting chemotherapy after surgery was immediate reconstruction. Flap surgeries allow for immediate breast reconstruction. This type of surgery requires a long recuperation period. Chemotherapy impedes healing. All incisions must be healed and all drains removed before chemotherapy can start.

I chose breast implants for reconstruction. This process was partially started during my mastectomy — consider it partially immediate reconstruction. A tissue expander was put in after they removed my breast. Recovery time is significantly less than with flap surgery. I still had some stitches in when chemo started.

Testing and imaging delays

Testing such as 21-gene reverse-transcription polymerase chain reaction assay testing and MRIs increased the time frame from lumpectomy or mastectomy to the start of chemotherapy. Some doctors use post-surgical MRIs to determine if clear margins were reached. If they are unhappy with the results of the MRI, a second surgery may be required, thus increasing the time before chemo can start.

My oncologist did not feel that any further testing other than a MUGA scan was necessary following my mastectomy. The MUGA scan was performed in order to check heart function before starting on treatment with a monoclonal antibody. Even though I had to go through this imaging, it did not delay the start of chemotherapy.

Other delays

One of the biggest causes of delays in starting chemotherapy treatment in minority women was access to health insurance. Black women who received Medicaid had the longest wait between surgery and the start of chemotherapy when compared to white women with private insurance. This is something that needs to change. When dealing with breast cancer, the faster and more aggressively it is treated, the better the prognosis for survival. There is no reason a woman should have to wait for treatment just because the government is paying for the chemotherapy.

Twelve weeks is too long to wait to start chemotherapy after surgery. Imaging should not have an impact on how long a person waits for chemo. Waiting too long, especially with aggressive forms of breast cancer could be the difference between life and death. I had imaging and started chemo just four weeks after my mastectomy. My outcome might have been very different had I been forced to wait an additional eight weeks before I started chemotherapy.

Lynda Altman was diagnosed with breast cancer in November 2011. She writes a series for Yahoo! Shine called “My battle with breast cancer.”

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Firefighters ambushed by gunman while responding to house fire

Residence near shooting and fire in Webster evacuated. (Max Schulte/Rochester Democrat&Chronicle via Twitter)

A man with a criminal history shot and killed two West Webster, N.Y. firefighters and seriously injured two others as they responded to a fire at his home in Webster, N.Y., police say.

William Spangler, 62, apparently started a 5:35 a.m. fire at his home on Lake Road  and then waited with an armament for first responders to arrive to the scene, Webster Police Chief Gerald Pickering said at an afternoon news conference.

“He was shooting from high ground or a berm," Pickering said. "He was barricaded with weapons to shoot first responders."

Spangler shot and killed himself at the scene, Pickering said.

Spangler was convicted in 1981 in the death of his grandmother a year earlier. He served time in prison and was released in 1998, Pickering said.

Local police had not noted any criminal activity in his recent past, Pickering said.

Pickering said they are looking into the apparent disappearance of Pickering's sister who is unaccounted for at this time.

Police and fire officials are continuing to gather evidence and will inspect the seven homes that were destroyed in the fire that spread to nearby houses in the small lakeside town located 10 miles east of Rochester.

The victims in the shooting are Mike Chiapperini, also a lieutenant and public information officer with the local police department, and Tomasz Kaczowka, Pickering said.

"These are volunteers who get up in the middle of the night to fight fires. They don't expect to be shot and killed," a tearful Pickering said at the press conference.

Chiapperini was described by Pickering as a lifelong firefighter who started with the department's explorer program and had about 20 years of experience. Kaczowka was a younger firefighter who was on the force for about two years and was also a 911 dispatcher, he said.

West Webster firefighters Joseph Hofsetter and Theodore Scardino were seriously injured and are at Strong Memorial Hospital with gunshot wounds, a hospital spokeswoman said.  Scardino  has  injuries to his chest and lungs. Hofsetter was injured in the pelvis, the spokeswoman said at a media briefing. Both are in guarded condition, she said.

An off-duty police officer from nearby Greece, N.Y., John Ritter was also injured by shrapnel during the shooting, Pickering said.

Pickering said that one of the firefighters who survived made his way across a bridge to safety. The other three did not make it across, Pickering said. Police arrived and rescued the other three firefighters, but two were fatally shot, Pickering said.

The morning scene was described as chaotic as police and firefighters dealt with an immense blaze as well as gunshots,  local news station WHAM-TV  reports.

“I’m not aware of anything like this happening in Webster, obviously not a firefighter being fired upon,” Webster Fire Marshal Rob Boutillier told the Democrat and Chronicle.  Pickering described Webster as resort lakeside community that is quiet and usually peaceful.

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British retailers start online sales early

LONDON (Reuters) – British retailers have brought forward their Christmas clearance sales online in the hope that shoppers will log on to buy bargains and offset lackluster spending in stores.

Marks & Spencer launched its sale online at midday on Monday, it said on its website, while department store John Lewis said it would cut online prices when its stores close at 1700 GMT. Debenhams has already started its online sale.

Retailers in recent years have started sales online on Christmas Day, ahead of the clearances in stores from Boxing Day, but are increasingly launching their online offers before Christmas after delivery deadlines for the day have passed.

Hard-pressed shoppers have been leaving it later to buy presents in the hope that retailers would slash prices, the British Retail Consortium said.

It was forecasting that 5 billion pounds ($ 8.1 billion) would be spent in the shops on Saturday and Sunday combined, the last weekend before Christmas.

Richard Dodd, the BRC’s head of Media and Campaigns, said weekend trading had met expectations.

“Christmas, ultimately once all the final sums are done, will turn out to be acceptable but not exceptional,” he said.

He said the sector expected a modest increase in cash spending against a year go, but not necessarily any significant increase in real terms once inflation was stripped out.

Many British families‘ budgets are stretched, according to a survey from Markit that showed the biggest deterioration in household finances for seven months.

Analyst Howard Archer at IHS Global Insight said the weakening in household finances could not come at a worse time for retailers, and it highlighted why many people appeared to have been careful in their Christmas shopping this year.

“The suspicion has to be that consumers will be especially keen to take advantage of genuine major bargains in the sales to acquire items that they cannot otherwise afford or are reluctant to make at the moment,” he said.

“However, we suspect that people will likely to be more careful in buying – or reluctant to buy – items that they don’t really want or need in the sales.”

($ 1 = 0.6180 British pounds)

(Reporting by Paul Sandle; Editing by Louise Heavens)

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Firefighters ambushed by gunman while responding to house fire

Residence near shooting and fire in Webster evacuated. (Max Schulte/Rochester Democrat&Chronicle via Twitter)

A gunman set a trap and shot and killed two firefighters responding to an early morning blaze in Webster, N.Y., police officials said. Two other firefighters were in serious condition.

"It does appear that it was a trap that was set for first responders, but the cause or reasons we don't have at this time," said Webster Police Chief Gerald Pickering as he described  the scene where shots were fired at West Webster firefighters when they arrived at 5:35 a.m. to battle the blaze along Lake Road.

The apparent gunman was found dead at the scene, but it’s unclear if he was killed by  a self-inflicted gunshot or if it was from a weapon from police officers who were chasing him.

The victims were Mike Chiapperini, also a lieutenant and public information officer with the local police department, and Tomasz Kaczowka, Pickering said.

Chiapperini was described by Pickering as lifelong firefighter who started with the department's explorer program and has about 20 years of experience. Kaczowka was a younger firefighter and was a 911 dispatcher, he said.

West Webster firefighters Joseph Hofsetter and Theodore Scardino were seriously injured and are at Strong Memorial Hospital with gunshot wounds, a hospital spokeswoman said.  Scardino had had injuries to chest and lungs. Hofsetter was injured in the pelvis, the spokeswoman said at a media briefing.

Pickering said that one of the injured firefighters made his way across a bridge to get to safety. The other three had to be rescued by police when they arrived at the scene.

"These are volunteers who get up in the middle of the night to fight fires, they don't expect to be shot and killed," a tearful Pickering said at the press conference.

No more details were released on the gunman. Pickering said he was found dead at the scene with the apparent weapons used in the shootings.

The morning scene was described as chaotic as police and firefighters dealt with an immense blaze as well as gunshots,  local news station WHAM-TV  reports. The station also reports the firefighters who are involved are volunteer firefighters.

“I’m not aware of anything like this happening in Webster, obviously not a firefighter being fired upon,” Webster Fire Marshal Rob Boutillier told the Democrat & Chronicle.  Pickering described Webster as resort lakeside community that is quiet and usually peaceful.

There at least four houses that have been damaged by the fire along Lake Road, WHAM-TV reported. Firefighters had to leave the scene and stop battling the blazes while police secured the scene. They are back to fighting the fires, the station reports. They continue to battle the blaze.

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New Genetic Tests Determines Breast Cancer and Ovarian Cancer Risks

COMMENTARY | New research has uncovered that mutations in the PPM1D gene is associated with an increased risk of breast cancer and ovarian cancer. Unlike BRCA1 and BRCA2 mutations, the PPM1D mutation is not inherited. Instead, the mutation only shows up in the blood when breast cancer or ovarian cancer is present. Medical News Today quotes professor Nazneen Raham as saying, “This is one of our most interesting and exciting discoveries.”

Important discovery

PPM1D mutations are very important. Because of the way they show up in the blood, if you have this mutation you have a 1 in 5 chance of developing breast cancer or ovarian cancer. That is almost twice the average risk for breast cancer and it is 10 times the risk for ovarian cancer. Knowing if you carry this mutation will help women decide on imaging and other preventative treatments. Right now, the only genetic test we have is the BRCA test. As PPM1D shows, BRCA is not the only gene mutation that indicates and increased risk for breast or ovarian cancers.

The study

Unlike many recent studies that have so few participants it makes the data questionable, this study looked at 7,781 women with either breast cancer or ovarian cancer and compared the PPM1D gene to 5,861 women from the general population. This allows the results to be statistically significant because they looked at so many different results. What the study showed is that in the group of women who had cancer, the researchers found 25 faults in the PPM1D gene. In the group of women without cancer only one fault was found. From a statistical standpoint, those results are quite amazing.

This study proves that newer, more detailed gene sequencing is needed to help determine cancer risks. This is especially true for ovarian cancers, sometimes called the silent killer, because most times this type of cancer is not caught until very late stages. Women with a family history of breast cancer or ovarian cancer need more weapons for detection in their arsenal. BRCA testing alone does not cut it. In my case, I have a family history of cancer but no identified genetic issues, like BRCA. I wonder how many lives testing for PPM1D could save.

Lynda Altman was diagnosed with breast cancer in November 2011. She writes a series for Yahoo! Shine called “My battle with breast cancer.”

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New Zealand level series thanks to Guptill century

EAST LONDON, South Africa (Reuters) – A brilliant, unbeaten century from opener Martin Guptill led New Zealand to an eight-wicket victory off the final ball against South Africa in the second T20 international on Sunday.

Chasing 169 for victory in 19 overs at Buffalo Park, Guptill helped erase the memory of Friday’s embarrassing capitulation to 86 all out in Durban with a stunning batting display as the tourists reached their target for the loss of just two wickets to level the series 1-1.

Requiring 39 from the final four overs and 11 off the last, Guptill was on 97 and needing four for victory when Rory Kleinveldt bowled the final delivery – a low full toss which was eased away through extra cover.

Guptill’s unbeaten 101 was just the third T20 international century by a New Zealander, the first two belonging to captain Brendon McCullum who was almost anonymous with 17 from 15 balls during a second-wicket partnership of 73 with Guptill.

The right-handed opener was similarly dominant during an opening stand of 76 with Rob Nicol (25) as he drove the Proteas attack impeccably straight and displayed the skills – and patience – so obviously missing from the New Zealand batsman in Durban.

Captain Faf du Plessis led from the front once again as South Africa posted a competitive 165-5 in 19 overs after losing the toss and being asked to bat first.

Du Plessis paced his innings to perfection on a tricky pitch to reach 63 from 43 balls with eight fours and a six in a match reduced to 19 overs per side following a 52-minute floodlight failure.

The deciding match takes place in Port Elizabeth on Wednesday.

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Quentin Tarantino unchains America’s tormented past in “Django”

LOS ANGELES (Reuters) – Twenty years after Quentin Tarantino unveiled his first film “Reservoir Dogs,” the director has turned his eye to America’s slavery history, spinning a blood-filled retribution tale in his trademark style for “Django Unchained.”

Tarantino, 49, has become synonymous with violence and dark humor, taking on the Nazis in “Inglourious Basterds” and mobsters in “Pulp Fiction.”

In “Django Unchained,” to be released in U.S. theaters on Christmas Day, he fuses a spaghetti Western cowboy action adventure with a racially charged revenge tale set in the 19th century, before the abolition of slavery in the United States.

Jamie Foxx stars as a slave whose freedom is bought by a former dentist, played by Christoph Waltz. The two set off as bounty hunters, rounding up robbers and cattle rustlers before turning their attention to brutal plantation owners in America’s Deep South.

Tarantino is well-versed in delivering violence. But the director said he faced “a lot of trepidation” about filming the slavery scenes. He has already come under fire from some critics for the frequent use in the film of the “N-word” – a racial slur directed at blacks.

The director said he was initially hesitant to ask black actors to play slaves who are shackled and whipped, and even considered filming outside of the United States.

But a dinner with veteran Oscar-winning actor Sidney Poitier, whom Tarantino called a “father figure,” changed his mind after Poitier urged him to not “be afraid” of his film.

“This movie is a deep, deep, deep American story, and it needed to be made by an American, and it needed to star Americans. … Lots of the movies dealing with this issue have usually had Brits playing Southerners and it creates this arm’s-distance quality,” Tarantino said.

Much of the film’s more graphic slavery scenes, such as gladiator-style fights to the death and being encased naked in a metal hot box in the heat of the Southern sun, are drawn from real accounts.

“We were shooting on hallowed ground. This was the ground of our ancestors. … Their blood was in the grass, there’s still bits of flesh embedded in the bark,” Tarantino said.

The film has received good reviews from critics and is expected to add Oscar nominations in January to its five Golden Globe nods.

With the exception of Waltz, who plays eccentric German bounty hunter Dr. King Schultz, the majority of the main players are not only American but from the South.

“It seemed sacred to us, and we couldn’t help but channel those emotions, everybody on the crew and on the set. … Those were very moving days,” Tarantino said.

‘DESPICABLE’ CHARACTERS

Tarantino reunited with Waltz, who won an Oscar in 2010 for his role as a menacing Nazi officer in “Inglourious Basterds,” and long-time collaborator Samuel L. Jackson, who plays slave housekeeper Stephen, a character who Tarantino described as “the most despicable black (character)” in movie history.

“Stephen might be frankly the most fascinating character in the whole piece, and it was important to deal with that whole upstairs-downstairs aspect of the Antebellum South,” he said.

The role that has people talking is Leonardo DiCaprio‘s first villainous turn as a racist plantation owner – a stark contrast from his Hollywood heartthrob “Titanic” days and roles as eccentric Americans in “The Aviator” and “J. Edgar.”

Asked how he felt to be the first director to make DiCaprio a villain, Tarantino laughed, saying he felt “pretty darn good about it.” He commended DiCaprio for turning into a “Southern-fried Caligula,” referring to the tyrannical ancient Roman emperor.

“I saw him as a petulant boy emperor. … He has nothing but hedonistic hobbies and vices to indulge him, and it’s almost as if he’s rotting from the inside,” Tarantino said.

The film’s female lead, Django’s wife Broomhilda played by Kerry Washington, moves away from Tarantino’s fierce screen women such as Uma Thurman in “Kill Bill” and Diane Kruger in “Inglourious Basterds.”

Tarantino said Broomhilda was meant to be the “princess in exile.” He said he was “annoyed” when he was asked by a friend why Broomhilda did not exact revenge on her abusers in the same way as Thurman’s “Kill Bill” character. The film, he said, is “Django’s story.”

“It invokes … that odyssey that Django goes on and gives the black slave narrative the romantic dimensions of great opera or great folklore tales,” Tarantino said.

(Editing by Jill Serjeant, Patricia Reaney and Will Dunham)

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3-day trip becomes 3-week ordeal for 2 Jamaicans

SAN JUAN, Puerto Rico (AP) — It was supposed to be a three-day fishing trip at most. It turned into a three-week ordeal, drifting under an intense sun for hundreds of miles in the Caribbean in a small boat with a broken motor.

The two Jamaican fishermen survived by eating raw fish they caught and drinking water from melted ice they had brought to preserve their catch. The Colombian navy finally plucked them from the sea a week ago and delivered them home Saturday after treating them for severe dehydration, malnutrition and hypothermia.

Everton Gregory, 54, and John Sobah, 58, recounted their story in a telephone interview from Jamaica, while the boat owner and the men’s employer also provided details.

The men set off from Jamaica’s southeastern coast on Nov. 20. The water was glassy, the wind was calm and their boat was laden with 14 buckets of ice, 16 gallons of water and several bags of cereal, bread and fruit.

They headed to Finger Bank, a nearby sand spit 8-miles-long (13-kilometers) that is known for its abundance of fish like wahoo, tuna and mahi mahi. The owner of the 28-foot (8-meter) boat said she usually joins them on fishing trips, but she couldn’t go that afternoon.

After spending a couple of days around Finger Bank, the two men set off for home with their catch. But the boat’s engine soon died. The water was too deep to use the anchor and the current too strong to use the oars, so the boat slowly drifted away from Jamaica.

At first, the men got by on sipping the water and eating the food they brought with them. But days turned into weeks, and they began to eat the fish they had caught and drink the melted ice that had kept it fresh.

Gregory and Sobah kept eating raw fish and used a tarp to try to collect water, but the rain clouds remained at a distance.

Back home, friends and family called police and used their own boats to search the area where the men were last seen. The two fishermen work for the Florida-based nonprofit group Food for the Poor, which chartered a plane to search along Jamaica’s coast.

Marva Espuet, the owner of the boat, said she knew she had packed it with more food and water than needed for a three-day trip, but the thought provided little relief.

“If I had gone, there would have been two boats going,” said the 52-year-old woman, a longtime friend of both fishermen.

With searches proving fruitless, Sobah’s niece grew frantic, recalled Nakhle Hado, a fishing manager for Food for the Poor who helped lead the search. She “begged me that she wanted John back for Christmas,” Hado said.

Hado said some people believed the two men would never be found, but he and others didn’t give up. “My gut was telling me that they were still alive,” he said.

Hado said he had trained Gregory and Sobah on how to survive at sea.

“In case something happens, they don’t have to think twice. They know how to react,” he said. “It’s very important, their mental state.”

Gregory and Sobah finally ran out of fresh water and went several days without drink. A healthy human being can die from dehydration anywhere from three to five days without water.

Then on Dec. 12, a Colombian navy helicopter patrolling off the coast of that South American country spotted the men near Lack of Sleep cay, more than 500 miles (800 kilometers) from where they started. It took two days for a navy vessel to reach them because of bad weather. The men were hospitalized for several days at the Colombian island of San Andres before boarding a plane back home to Jamaica.

“It feels good,” Sobah told the AP in a brief phone interview after arriving.

Gregory said he had lost hope, but Sobah tried to keep him positive that they would be rescued. “I just had that belief,” Sobah said. “I believe in the Creator.”

Yet it is Gregory who plans to keep fishing despite the ordeal because he needs the job.

Sobah said he’s done. “I’m not going to go fishing again. No way.”

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South Africa’s Mandela responding to treatment in hospital

JOHANNESBURG (Reuters) – Former South African president and anti-apartheid hero Nelson Mandela, who is 94, continues to respond to treatment two weeks after being taken to hospital, the government said on Saturday.

The Nobel Peace laureate, who has been treated for a lung infection and gallstones after being hospitalized on December 8, was visited by South African President Jacob Zuma, presidency spokesman Mac Maharaj said in a statement.

“Madiba has been in hospital since the 8th of December and continues to respond to treatment,” Maharaj said, referring to Mandela by his clan name.

“President Zuma assured him of the love and support of all South Africans, young and old, and the whole world.”

The country’s first black president was admitted to hospital in Pretoria earlier this month after being flown from his home village of Qunu in a remote part of the Eastern Cape province.

It seems likely that Mandela, admired at home and abroad as a global icon against injustice for his lifetime of struggle against minority white rule, will end up spending Christmas in the hospital.

On Thursday, following his re-election as leader of the ruling African National Congress (ANC), Zuma reported Mandela had “steadily improved”.

Zuma said then the former president was receiving “the best care possible” but recalled that Mandela was “at an age where medical challenges require extraordinary care”.

He praised Mandela as an “unparalleled fighter”.

In an interview broadcast on Saturday but recorded a day earlier, the ANC’s newly elected Deputy President Cyril Ramaphosa said he believed Mandela was “on the mend”.

Mandela spent 27 years in apartheid prisons, including 18 years on the windswept Robben Island off Cape Town. He was released in 1990 and went on to use his prestige to push for reconciliation between whites and blacks as the bedrock of the post-apartheid “Rainbow Nation”.

He stepped down in 1999 after one term in office and has been largely removed from public life for the last decade.

Mandela spent time in a Johannesburg hospital in 2011 with a respiratory condition, and again in February this year because of abdominal pains. He was released the following day after a keyhole examination showed there was nothing serious.

He has since spent most of his time in Qunu.

His fragile health prevents him from making any public appearances in South Africa, although he has continued to receive high-profile domestic and international visitors, including former U.S. president Bill Clinton in July.

(Reporting by David Dolan; Editing by Pascal Fletcher)

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Former President George H.W. Bush remains hospitalized

(Reuters) – Former President George H.W. Bush, who has been hospitalized for a month undergoing treatment for bronchitis, may not be released from a Houston hospital in time to celebrate Christmas at home as doctors had hoped.

Bush, 88, remained in stable condition and doctors were optimistic he would make a full recovery, George Kovacik, a spokesman at Methodist Hospital, said in an emailed statement on Sunday.

But doctors were being “extra cautious” with his care and no discharge date had been set, the statement said. Earlier this month, Kovacik said doctors expected Bush would be able to spend Christmas at home with his family.

“His doctors feel he should build up his energy before going home,” the statement said.

Bush, the 41st president and a Republican, took office in 1989 and served one term in the White House. The father of former President George W. Bush, he also is a former congressman, U.N. ambassador, CIA director and vice president for two terms under Ronald Reagan.

(Reporting by Kevin Gray; Editing by Daniel Trotta and Vicki Allen)

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