Article attacks risk reduction and incidence of LE
Comments
-
Well, well!
The National Lymphedema Network has called upon its Medical Advisory Committee to make a statement in response to this article. Here's what they have to say:In response to an article published in the March issue of the Journal Of American College of Surgeons (http://www.journalacs.org/article/S1072-7515(12)01312-9/abstract) the NLN Medical Advisory Committee is responding to a Press Release released on February 25, 2013 (http://www.facs.org/news/jacs/lymphedema0313.html) in the Journal of American College of Surgeons, "Breast Cancer Patients Fear for Developing Lymphedema Far Exceeds the Risk "
Respectfully:
Saskia R.J. Thiadens RN
Executive DirectorMarch 1, 2013
On 2/25/2013 the Journal of American College of Surgeons released a statement entitled, "Breast Cancer Patients' Fear of Developing Lymphedema Far Exceeds the Risk." The press release was in response to findings from a single-site study published in the March issue of the Journal of the American College of Surgeons noting that some breast cancer survivors take extraordinary measures to try to prevent lymphedema that may not be necessary. The rate of development of lymphedema in the limbs of the study patients (N=120, followed to 12 months) was similar to reported incidence in the medical literature. Three percent of patients having a sentinel lymph node biopsy developed lymphedema and 19% of patients having an axillary lymph node dissection developed lymphedema. The study indicated that patients with sentinel lymph node biopsy worried and took precautions as much as those who had axillary node dissections.
The National Lymphedema Network agrees with the statement in the press release that "future research should be aimed at better predicting which women will develop lymphedema, thus allowing for targeted prevention and intervention strategies and individualized plans for risk-reducing behaviors for each woman during and after her breast cancer treatment." However, since this type of risk stratification and broad education does not currently exist, it is important for patients to be given accurate information by their doctors and oncology care providers on reasonable approaches to reducing the risk of developing lymphedema.
The American Cancer Society estimates that in 2013 there will be about 232, 340 new cases of breast cancer in the US and there are approximately 2.9 million breast cancer survivors in the US. If 20% of those who have axillary dissections, and, conservatively, 3% with sentinel lymph node biopsies, are at risk of developing lymphedema, this is still a very large number of women who have reason to be concerned about their risk of developing lymphedema.
Lymphedema is a progressive, debilitating condition that is not merely swelling, but an immune system dysfunction. When recognized late in its course, or inadequately treated, lymphedema leads to chronic infection and progressive disability. Women who are at risk for lymphedema have reason to be concerned and these concerns should not be minimized.
The National Lymphedema Network advocates a reasonable approach to risk reduction guidelines, given that a large population of women is still at significant risk of developing lymphedema. In the NLN Position Paper on Risk Reduction, revised in 2012 and available at www.lymphnet.org , a risk stratification approach is detailed so patients can take appropriate precautions according to their medical situation. Every breast cancer survivor deserves accurate information about her or his risk of developing lymphedema and reasonable precautions based on the available scientific evidence.
The American College of Surgeons, and all providers of care to breast cancer patients, are encouraged to provide every breast cancer patient with accurate information about lymphedema, so patients can make informed choices. Given the imperfect state of the science on risk reduction for lymphedema, there are many reasonable, healthy suggestions for patients at risk of lymphedema to reduce their risk, such as weight management and exercise. The Position Papers on the NLN website on Exercise, Risk Reduction and Screening for Breast Cancer Related Lymphedema were written by a panel of medical experts in the field of lymphology and lymphedema treatment.
The National Lymphedema Network urges the American College of Surgeons to endorse the NLN Position papers, provide them to their members, and acknowledge that a large number of breast cancer survivors are at risk of or currently have lymphedema. These patients need education and information that will allow them to take precautions that are reasonable and not excessive. Education is the key and then what each one does with that information is a personal choice and a part of personalized health care.
Respectfully,
NLN Medical Advisory Committee
-
Hurrah for the NLN!
Thanks for posting this Binney!
Diana -
Hear hear , Binney!
-
Standing ovation for all those writing letters and getting the fact out there!!! So the findings of the naysayer was based on 120 people for ONE year??? How in the world can they even call that a fair study???? I don't think ENOUGH PEOPLE AND ENOUGH TIME were put into it.
I don't understand what that braud's beef with is with LE anyway?? Wouldn't you want to go out of your way to HELP EDUCATED, HELP REDUCE LE???? I think her butt is up her arse.
I can't provide the eloquent words, so I will use my white trailer trash language (only cleaned up a bit).
hee hee hee -
kira
Should this thread end up coming to a close, in light of the NLN response, I just want to thank you for bringing it to the forefront.
I have contacted a nearby LE support group with the article link as well as email addresses. I do hope a 'circle of support' can spread and continue to refute this study before it is has done harm.
-
Well, I think the NLN response isn't nearly strong enough, nor did they disseminate it, except to their members.
They accepted the 3% LE risk with SNB as a "conservative" estimate and 19% with ALND and those numbers are lower than the literature would indicate--for a disease with no diagnostic criteria.
I wrote to the head of the NLN to inform her about this, and I'm glad she responded via her MAC (medical advisory committee), but a polite response would have been nice. And personally, I'm glad they wrote something, but I still think they're weak on advocating for patients.
This study has been so upsetting and the response of the official LE groups has been dissappointing, for me.
So, I'll write a letter to the editor, and I think we all need to be vigilant, and don't assume that a handful of LE researchers have our best interests at heart, primarily, as they're researchers and play the academic game. Or in the case of the NLN, they have never held patients in high reguard.
Sorry to rain on the parade, but it is such a modulated response and refers you back to the NLN, who took the worst study ever and used it to justify not recommending compression for women at risk during air flight.
And this press release sure won't impact the surgeons who just read the press release and think no risk reductions and no LE: justification to continue to deny our reality and to legitmaze systematic ignorance, in the name of "don't worry" Therapeutic nihilism, as my textbook says...
-
Purple, I sure hope this thread won't just disappear as a result of the NLN's statement. As patients we really don't dare depend on any of the current LE organizations to represent our interests. Some of us nudged the NLN's leadership to take a stand on this, and we alerted them to the response that we patients are making. So they did respond, and they did it reasonably quickly. But we need to continue to represent OURSELVES, because nobody in the professional world is going to do it for us.
Onward!
Binney -
Oh, I had a feeling the NLN was " nudged" Binney.
Thanks.
I am dismayed by this :
", nor did they disseminate it"This is not fair. The published article can be used against us in all kinds of ways . Can emails be sent to the NLN asking them to disseminate this information and highlight it in some way as in direct oppostition to the study .
What more can be done ?
-
Purple, as Binney said we need to advocate for ourselves, in a calm, reasonable and professional manner.
Of course the useless NLN "press release" was only released to NLN members, and does not show up in any google alert. Useless. And insulting. They wrote it to shut us up, not to truly respond to the needs of patients.
-
Purple, as Binney said we need to advocate for ourselves,...
Yes, of course, kira. I understand, but is there no way a group of us can contact the NLN ( in that calm and professional manner) and ask them to make this ' more public" or ??
I am just wondering if there is more we can do to help. -
Purple, I think it's a good idea to let the NLN know that you want a more public response. Simply sending it out to their members is hardly enough. You--and lots of others, I hope--might request that they post it on their website and send it to the journal as well. Another prominent LE organization is framing their response, and I'm sure Kira will let us know when (and where) that is finally published. We (and Pat O'Connor) have also posted to other LE discussion groups, letting them know that they can write a response to the author and journal.
While the big professional organizations are important, they all have their own agendas, and that falls way short of encompassing our concerns. It's the voices of the patients that really matter, and nudging is definitely a group effort. So, go for it!
Binney -
will do!
I just got an email from an area support group that said they were happy the whole thing was ' put to rest' by the NLN ! -
Here's (for what it's worth
) is what I wrote, to the author, with cc to the journal editor:Dear Dr. McLaughlin,I want to thank you for your interest in the field of lymphology. It's not every day that a prominent medical journal touches on this subject area, and in this case the resulting discussion within the lymphedema community has been invigorating. I hope it will also end up being productive.As I'm sure you must already be aware, your research publication and the media reviews have sparked a strong (and unfortunately, mostly negative) response, especially from those of us with breast cancer-related lymphedema. My own diagnosis was nine years ago, and I struggle with a progressive deterioration of lymph transport capacity that has resulted in bilateral arm, hand and truncal lymphedema and, recently, lymphedema in my right lower leg. Like you, my surgeon was (and still is) opposed to offering patients encouragement to engage in risk reduction behaviors, though his basis for that preference has nothing to do with mistrust of observed clinical experience such as you express. In fact, he still asserts that none of his patients has ever developed lymphedema.His view is not unique. For far too many cancer patients (not only breast cancer), denial of the seriousness of this condition by our medical providers, as well as underestimation of individual risk, leads to tragic and life-changing "surprises" when the condition manifests.Of course your perspective and agenda as a surgeon, and mine as a patient, will never be the same—nor should they be. But we have much to offer each other by way of increasing the understanding and treatment efficacy of this unfortunate condition. I will try to make this applicable to at least one of the issues that concerns you and your colleagues as surgeons. Specifically this: when you propose to limit our access to the information that can make us active participants in the prevention, diagnosis, and early treatment of our condition, you sacrifice our trust in both your wisdom and your intentions.As a patient advocate, I have seen this trust destroyed over and over again as women with new lymphedema learn for the first time that there were choices they might have made, knowledge they might have gained, and earlier intervention that might have been possible. Had they only been told.Thank you again for caring.Sincerely, -
GREAT job, Binney! I am sure the DR. will reply ... if she has time
edited to add : BINNEY, I just keep re-reading this/your line. I love it. You go, girl!when you propose to limit our access to the information that can make us active participants in the prevention, diagnosis, and early treatment of our condition, you sacrifice our trust in both your wisdom and your intentions.
================I just emailed the following to :
nln@lymphnet.orgAttn: Saskia R.J. Thiadens , R.N.
To whom it may concern:
I would like to begin by expressing my sincere gratitude for your response to the article: " Breast Cancer Patients' Fear of Developing Lymphedema Far Exceeds the Risk."
As an LE patient, I found the article to be offensive and trivializing at best and potentially dangerous and reckless. I was certainly heartened to see that the NLN Medical Advisory Team issued a statement in a timely manner encouraging the American College of Surgeons to educate those at risk for lymphedema.
Having said that, as a LE patient, I am hoping for more from the NLN. I am hopeful that you will write to the journal, as I did, and express your concerns. Additionally, I would expect you might ask that your statement be published in the A.C.S. journal in direct response to the article. After all, in order to make an impact, you must be ‘heard’. I would say that the NLN knows better than anyone that the voices of those with lymphedema have been voices crying out into the wilderness. This does not have to be the case with a large network such as yours who can and does do so much good.
In the same vain, I was disappointed that the NLN response is only disseminated to members and not to the public at large who could benefit from this information. My own personal crusade is that one more person need not develop LE due to misinformation or lack of information. I feel like a drop of water in the vast ocean. On the other hand, The NLN has the power to make a real difference. I trust that you will circulate this information to all, publicly, so that as many people as possible can benefit from it. I am hoping to see it featured on your website. I imagine this would not be too difficult a task.
Once again, I would like to thank you for taking the time to respond to what may be “risky” article ( pun intended) and I have faith that you will not abort the mission before it has been completed. There is so much work to be done!
Most Sincerely,
-
Binney, excellent job! Thank you!
My surgeon also claims that he does not have LE among his patients. My PT is so funny. As she is massaging away she will chit-chat. So when I told her what my surgeon had said, she observed cooly that he (this is a small town and she knows the leading BC surgeons and their patients) does indeed have a lower incidence of LE but higher incidence of frozen shoulder, whereas his colleague X has a higher LE incidence, but less frozen shoulder. She also said that all the surgeons think they are gods.
-
Purple, did you read the article? Because the article was much less inflammatory than the press releases, and you really should read the entire article to comment on it.
I found the press releases far more problematic than the article itself.
Here is the conclusion of the abstract of the article:
Upper extremity volumes fluctuate, and there is a period of latency before development of lymphedema. Despite the low risk of lymphedema after SLNB, most women worry about lymphedema and practice risk reducing behaviors. Additional study into early upper extremity volume changes is warranted to allay the fears of most women and better predict which women will progress to lymphedema. (J Am Coll Surg 2013;216:380e389. ! 2013 by the American College of Surgeons)
Yes, it implies that LE concerns most women, and that there was, as defined in this study, a low incidence of LE after SNB. If the diagnostic criteria for LE were changed to 5% volume increase, or swelling reported, the incidence would have doubled or tripled.
It's a serious problem in LE research that we don't have a single diagnositic criteria for LE. It skews the data and conclusions.
The NLN is intending to put their press release on their site, I've been told.
Binney: When I read your masterful letter, I want to cry, because it's so powerful. I can never thank you enough for the support you've given me and the crucial knowledge you gave me when I was so lost and terrified, and could only take it in it bits and pieces. You're a tireless advocate and educator. And you do it with such grace.
-
Purple, did you read the article?
Yes, I did. Thank you.
I am glad to hear that is going on their website.
THX
*EDITED TO ADD: I found the press releases far more problematic than the article itself.
I agree completely, but I think this is what happens when you go mixing apples with oranges. I dont think all this mention of worry etc... has anything to do with the actual process of LE. I didnt worry - I was too ignorant to. If you ask people( study particpants) certain questions, you will get certain answers. It's a set up in a sense ( IMO.)
Dr. MacLaughlin told me that she could not change what people said to her, but only report it. I get that .Here is my response:"Please understand - I most certainly do not expect, nor do I believe I implied, that you should change the responses of your patients. Rather, I stated that I do not believe these questions ( e.g. fear, worry or anxiety levels) have anything to do with developing LE and are not causal, unlike surgery. I feel they divert from the more serious issue that we LE patients would like to see addressed. " .....
I guess that's one of the things that have inflamed so many - me anyway.
-
I just happened upon this discussion, and read all the posts. As someone who had an SNB with 4 nodes removed, I am concerned about LE. Neither my BS nor my PS, neither my MO nor RO, ever discussed the possibility of LE with me. If it wasn't for you ladies like Binney, Carol, Purple and others I still would have been blissfully unaware. You are doing a very great and commendable job in educating bc patients about LE.
So I want to thank you sincerely from the bottom of my heart for your tireless advocacy re LE. Thanks to your knowledge and insight I have been applying the preventative measures that I've read about on these boards which I otherwise never would have known about. I often fly, and don't even want to think about what can happen if I do not wear a sleeve every time. I don't have LE, at least not yet, but I am sure as hell not going to tempt fate, and will apply every measure that I have learned here to prevent a chronic LE situation. Recently had eye surgery, and made 100% sure they knew that my left arm was totally off limits. They respected that, and seemed to be familiar that that is the case with bc patients.
Dr. MacLaughlin had opened a can or worms, and I sincerely hope she will deal with it appropriately, and will make an effort to really understand and address our very legitimate concerns. Purple, you are spot on with your statement to this doctor in your last post. Bravo!!!
-
Thank you. lifeie!
It's my pleasure because as you said : "I still would have been blissfully unaware...."
and so would I if not for Binney, Carol, kira and all the others who have been working very hard at this for a very long time! -
The following was sent to the writer of the Press Release, which contained some of the more inflammatory statements which were not in the original article. A shorter, more scientific response was sent through the on-line author submission channel for publication in the on-line version of the Journal. It is currently under review by the Editor.Comments on American College of Surgeons’ Press Release Dated February 25, 2013Re: Breast Cancer Patients’ Fear of Developing Lymphedema Far Exceeds RiskThe conclusions highlighted in the press release are based on a biased selection of a lymphedema measurement standard and the results of a study of inadequate length.There is general consensus that there is no standard method for definition and measurement of lymphedema. Some measures are more sensitive and, when used, yield higher estimates of lymphedema incidence than would be obtained using less sensitive measures [Armer and Stewart 2005]. Of the four commonly used methods of defining lymphedema investigated by Prof. Armer (i.e. 2-cm circumferential change, 200-mL volume change, patient-reported signs and symptoms and 10% volume change), the method selected in the McLaughlin study is by far the least sensitive measure and defines the lowest lymphedema incidence. Choice of a less conservative measure would have resulted in a more appropriate match of patient concerns with their risks of lymphedema. A 6% excess matches the patient subjective rate in a study by Edwards in 2000. And a 3% rate is being used in current studies of the prevention of lymphedema.A biased selection of lymphedema measure leads to another inaccurate conclusion. Current medical and economic studies support early detection and prevention of disease as a cost-effective means of avoiding progression to harder-to-treat stages. The “prospective surveillance model” is a current proposed lymphedema care delivery system that would define early-stage breast cancer-related lymphedema when swelling reached 3% during the first year after breast cancer treatment. Lymphedema detected with this criterion would be treated with an inexpensive 20- to 30-mmHg compression sleeve for one-month periods. [Stout Gergich 2008, Stout 2012] It is believed that maintaining the lymphedema at a sub-clinical stage during the first year will prevent or retard the destructive tissue changes in a swollen lymphedema limb that define the progression of lymphedema.Another recently studied lymphedema care delivery model based on lymphedema early detection and intervention would provide manual lymph drainage (MLD) to the limb of a breast cancer patient from day 2 after treatment and throughout the first year. This concept is applied in a six-month study to trial groups undergoing sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND), with and without radiotherapy. The investigators measured percent excess arm fluid and provided intervention to all members of the intervention group. While average excess fluid due to lymphedema in the women in the control group, who received no MLD, grew monotonically from zero to +10% at 6 months, the average excess fluid dropped monotonically in the MLD group from +1% to -1.5%. “This study demonstrates that regardless of the surgery type and the number of the lymph nodes removed, MLD effectively prevented lymphedema of the arm on the operated side. Even in high risk breast cancer treatments (operation plus irradiation), MLD was demonstrated to be effective against arm volume increase.” [Zimmermann 2012].Dr. McLaughlin ought to give women a bit more credit than to posit “And because women worry about that disfiguring process, they adopt practices that are basically grounded in myth, not fact.” Women are also concerned about the additional risk of infection that is connected with lymphedema, the pain and secondary musculoskeletal conditions caused by the additional limb weight, neurological conditions such as carpal tunnel syndrome which are connected with the tissue swelling, and inability to type or dice vegetables with swollen fingers. (It is a myth that lymphedema is a “painless swelling of the arm”.) Many recommended risk-reduction practices are based on the clinical and societal experiences of a lymphedema-aware medical community in Europe and Australia over the last 50 years. They may not be “evidence-based” but are hardly “myths”.The paper states “However, 90% of women who will develop lymphedema do so within 3 years of breast cancer treatment.1,2” when in fact Petrek2 says 77% at 3 years and Norman1 finds 80% at 2 years and 89% at 3 years. Exaggeration to make a point may be appropriate in a work of fiction, but it is bad taste in a medical journal. The onset of lymphedema after surgical breast cancer treatment may not occur until 7 (range 1-37) months. After a combination of surgery and radiotherapy the onset of lymphedema may be a longer 12 (range 1-52) months, and for radiotherapy only, 25 (range 6-156) months [Pierquin 1986]. The 12-month duration of the study is not long enough to make any statements on relationships between lymphedema and radiation therapy.The final suggestions of the author for further research aimed at better predicting which women are at higher risk of lymphedema allowing targeted prevention and intervention strategies, and individualized plans for risk-reducing behaviors, are appropriate and well taken. But minimizing the risk of lymphedema by selecting biased measures, and then sending the “average woman” off into survivorship unprepared for its occurrence until it is too advanced to treat economically, is not wise. Giving the patient the tools for prevention and self-treatment if it becomes necessary is empowering, and should not be anxiety-provoking.Robert Weiss, MSIndependent Lymphedema Patient AdvocateCitations:• Armer & Stewart 2005: Armer JM and Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphatic Res Biol. 2005;3(4):208-217.• Edwards 2000: Edwards TL. Prevalence and aetiology of lymphoedema after breast cancer treatment in Southern Tasmania. Aust N Z J Surg. 2000;70:412-418.• Norman: Norman SA, Localio AR, Potashnik SL et al. Lymphedema in breast cancer survivors: Incidence, degree, time course, treatment and symptoms. J Clin Oncol. 2009;27:390-397.• Petrek: Petrek JA, Senie RT, Peters M et al. Lymphedema in a cohort of breast cancer survivors 20 years after diagnosis. Cancer 2001;92:1368-1377.• Pierquin 1986: Pierquin B, Mazeron J-J and Glaubiger D. Conservative treatment of breast cancer in Europe: Report of the Groupe Européen de Curiethérapie. Radiotherapy Oncol. 1986;6:187-198• Stout 2012: Stout NL, Pfalzer LA, Springer B et al. Breast cancer—related lymphedema: Comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther.2012;92(1):152-163.• Stout Gergich 2008: Stout Gergich NL, Pfalzer LA, McGarvey C, et al. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 2008;112(12):2809-2819.
• Zimmermann 2012: Zimmermann A, Wozniewski M Szklarska A et al. Efficacy of manual lymphatic drainage in preventing secondary lymphedema after breast cancer surgery. Lymphology 2012;45:103-112
Robert Weiss, M.S.
Lymphedema Patient Advocate -
Wow.
Thank you, LymphActivist!
Thank you, Binney!
Thank you, Kira. -
WOW!
Thank you indeed!This line really hit me hard : " MLD effectively prevented lymphedema of the arm on the operated side. Even in high risk breast cancer treatments (operation plus irradiation), MLD was demonstrated to be effective against arm volume increase.” [Zimmermann 2012].
Such a simple technique- to think many of us might have prevented this !
-
Thank you Bob!
What is with the NLN??? They write a press release and NEVER release it, and it's so carefully worded as to not address the issue.
My letter to the editor wasn't nearly so well reasoned, and while I heard back from the author, not the editor. I didn't cite references, other than in passing (like AW Stanton says...)
-
I heard back from the editor, but there was nothing in her comments to suggest they would consider publishing my patient's rebuttal to the study. Bob's is so well argued, with strong evidence as support for his points, that I hope there's a real chance the journal will publish it. We can only hope.
-
Thank you all for your responses to this research! I am so glad you are speaking out for us. It is so frustrating to read these reports from my perspective considering I do NOT even have breast cancer and I developed LE. I had one single infarcted node removed and now I am struggling with LE because my surgeon did not provide adequate information about LE after my surgery.
My husband is a PT student and he is obviously fascinated with LE now because of my situation. He is planning on performing a literature review on LE in the near future. When we get the results I will be sure to let you all know. I just wanted you to know that there ARE professionals who treat this seriously and want to improve the research that is out there.
Holly
-
Add another WOW from me. Bravo!!
-
Hmm, I never heard from the editor. And the official LANA response was never sent, to my knowledge and an expert we asked to review and respond has been too busy, even when a close associate asked as well.
Holly, have your husband check out our stepupspeakout.org site, we did a lot of literature searches, and I became a CLT, he can also. http://www.stepup-speakout.org/
It sure does add insult to injury to be told " not to worry" when we never got the information we needed in the first place
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team