A virtual breast cancer support group offered in Spanish. Después de un Diagnóstico No events at the moment Después de un Diagnóstico

Conferences & Presentations March 15-20, 2019, Las Vegas, NV National Consortium of Breast Centers 29th Annual Interdisciplinary Breast Center Conference February 15, 2019, Naples, FL University of Pittsburgh 2019 Winter Academy February 16, 2019, Naples, FL Magee-Womens Research Institute Symposium October 15, 2018, Boston, MA Exhibitor at the Asian Women for Health CelebrAsians event for breast cancer awareness month September 30, 2018, Philadelphia, PA Exhibitor at the Living Beyond Breast Cancer Conference in Philadelphia, PA February 28-March 2, Clearwater, FL 2018 Carol Carfang Nursing & Healthcare Ethics Conference Media Press Conferences &Presentations

Be empowered, meet others who get it, ask questions, share your story, and become part of an online community that will support you from day one and beyond. This is your online breast cancer support group. Always Connected. Never Alone. Breast Cancer Support There are several ways to get support through our online communities. Our global network provides opportunity for you to connect with others who have been touched by breast cancer in a safe and supportive environment. Our online communities enables you to receive peer-to-peer support where you can ask questions, share tips, and know you are not alone in this experience. Our network consists of those diagnosed with breast cancer, survivors, thrivers, caregivers, medical professionals, advocates, and friends. Online Breast Cancer Support Groups Después de un Diagnóstico Tue, Feb 21 Después de Un Diagnóstico More info Details Arteterapia Tue, Feb 07 Arte terapia para el Alma More info Details Multiple Dates Después de un Diagnóstico Tue, Dec 20 Virtual More info Details Multiple Dates Thursday Nights Thrivers Meetup Thu, Dec 15 Virtual More info Details Reflect and Recharge with Thomas Dooley Mon, Dec 12 Online Event More info Details Multiple Dates 15 Minute Heart Chakra Chanting with Gloria Mon, Dec 12 Online Event More info Details Multiple Dates Thursday Night Thrivers IBC Meetup Thu, Dec 08 Online Event More info Details Food & Fitness For the Cancer Survivor Tue, Dec 06 webinar More info Details Multiple Dates Thursday Nights Thrivers MBC Meetup Thu, Dec 01 Virtual More info Details Thursday Nights Thrivers MBC Meetup Thu, Dec 01 Virtual More info Details Multiple Dates 15 Minute Solar Plexus Chakra Chanting with Gloria Mon, Nov 28 Online Event More info Details Chair Yoga 4 Cancer with Tamera Mon, Nov 21 Online Event More info Details Art Therapy for Healing your Body Image with Stephanie Mon, Nov 21 Online Event More info Details Reflect and Recharge with Thomas Dooley Mon, Nov 14 Online Event More info Details Understanding Long-Term Disability Insurance Thu, Nov 10 webinar More info Details Restorative Yoga with Kate: Fall Into Meditation Mon, Nov 07 Online Event More info Details Thursday Nights Thrivers MBC Meetup Thu, Nov 03 Virtual More info Details Multiple Dates 15 Minute Sacral Chakra Chanting with Gloria Mon, Oct 31 Online Event More info Details Load More Despite the circumstances in which we are meeting (breast cancer and all) I am glad you are here and welcome you to our SBC Community. Join our Online Community Explore Online Workshops Healing Through the Arts Explore Attend Online Movement Classes MOVING MONDAY JOIN US Get Matched With A Mentor. Through our partnership with ABCD and Project Life, you can now get free one-to-one support from a professionally-trained Mentor who has been diagnosed with Breast Cancer and who is similar to you. Here’s how it works: Early Stage: If you are diagnosed with early stage breast cancer, i.e., stages I-III, complete the ABCD intake form on their website and they will be in touch to match you with a mentor. Late Stage: If you are diagnosed with late stage breast cancer, also referred to as metastatic breast cancer or stage IV, Project Life offices mentors whether you were diagnosed de Novo, had a recurrence leading to MBC, or are experiencing progression, contact mentorship@projectlifembc.com to get matched. These services are free, completely confidential and always available. When completing the ABCD form or emailing Project Life, be sure to indicate you heard about the program from Survivingbreastcancer.org! Join the community! Have access to discussion boards, insider news and information, and make connections. Join a Group Today

Breast Cancer Poetry Writing is a great form of therapy and healing. Enjoy the original compositions from our Survivingbreastcancer.org Community! Be Inspired. Submit Your Poem Después de un Diagnóstico Tue, Feb 21 Después de Un Diagnóstico Share Details Arteterapia Tue, Feb 07 Arte terapia para el Alma Share Details Multiple Dates Después de un Diagnóstico Tue, Dec 20 Virtual Share Details Multiple Dates Thursday Nights Thrivers Meetup Thu, Dec 15 Virtual Share Details Reflect and Recharge with Thomas Dooley Mon, Dec 12 Online Event Share Details Multiple Dates 15 Minute Heart Chakra Chanting with Gloria Mon, Dec 12 Online Event Share Details Multiple Dates Thursday Night Thrivers IBC Meetup Thu, Dec 08 Online Event Share Details Food & Fitness For the Cancer Survivor Tue, Dec 06 webinar Share Details Multiple Dates Thursday Nights Thrivers MBC Meetup Thu, Dec 01 Virtual Share Details Thursday Nights Thrivers MBC Meetup Thu, Dec 01 Virtual Share Details Multiple Dates 15 Minute Solar Plexus Chakra Chanting with Gloria Mon, Nov 28 Online Event Share Details Chair Yoga 4 Cancer with Tamera Mon, Nov 21 Online Event Share Details Art Therapy for Healing your Body Image with Stephanie Mon, Nov 21 Online Event Share Details Reflect and Recharge with Thomas Dooley Mon, Nov 14 Online Event Share Details Understanding Long-Term Disability Insurance Thu, Nov 10 webinar Share Details Restorative Yoga with Kate: Fall Into Meditation Mon, Nov 07 Online Event Share Details Thursday Nights Thrivers MBC Meetup Thu, Nov 03 Virtual Share Details Multiple Dates 15 Minute Sacral Chakra Chanting with Gloria Mon, Oct 31 Online Event Share Details Load More Migración y Cáncer: Una Historia de Lucha, Esperanza y Resiliencia Poetry Elisa Herrera Mar 20, 2025 1 min read A todas las madres, en todas las formas Blog Elisa Herrera May 9, 2024 1 min read Never miss a beat. Stay connected with SBC on Social for daily updates, news, and information! Follow Us Contact us laura@survivingbreastcancer.org 5 Cedar Street, Boston, MA © 2022, Registered 501(c)(3). EIN 82-2953427

The Carfang Group presents eleven issues that will change the financial world.  We call these the “Megatrends”.  This article presents the eleven megatrends and invites your feedback and discussion.  Subsequent articles will explore each of these in detail. Megatrends in Treasury, Money and Banking Megatrends in Treasury, Money and Banking Anthony J. Carfang, The Carfang Group Innovation, technology, regulation and geopolitics are intersecting and are about to change the face of treasury, money and banking as never before. Issues that appear small or incremental today could be seismic in the longer term. As markets, institutions and governments deal with these cross-currents, we could be witnessing the beginning of a transformation on a grand scale in finance. In this series, The Carfang Group presents eleven issues that will change the financial world. We call these the “Megatrends”. This article presents the eleven megatrends and invites your feedback and discussion. Subsequent articles will explore each of these in detail. These are the eleven Megatrends which we believe will reshape our financial world over the next decade. Central Bank roles are scaled back. Asset Managers overtake banks. Deposit Banking diminishes in importance. Deposit Insurance becomes universal. Private Liquidity Funds emerge as a major asset class. Technology disintermediates the intermediaries. Truly immediate payments eclipse “faster payments”. 20th century institutions and structures are realigned. Currency takes on a new role. Alternative currencies gain acceptance. Solutions for the underbanked take shape. About the author: Anthony J. Carfang is Managing Director of The Carfang Group and has a distinguished background in consulting, writing, speaking, thought leadership and advocacy in the area of treasury, payments and liquidity. He encourages you to provide feedback on this article or any other issues to tony_carfang@carfang.com . You can follow Tony at https://www.linkedin.com/in/carfang/ Central Bank roles are scaled back. To receive a pdf version of this white paper, email tony_carfang@carfang.com ." Central Bank roles are scaled back. Without question, many central banks functioned superbly during the financial crisis in the dual roles of lender of last resort and payment guarantor of last resorts. They forcefully took on powers necessary to prevent a worldwide depression. Instead of reverting to their historical role after the crisis abated by 2011, they continued to function in crisis mode and now seem to have taken for themselves an entirely new mandate of economic support. We believe that this will come under close scrutiny over the next decade and the missions of central banks world-wide will be scaled back. Consider the following “last resort” moves that remain in place ten years post-crisis: Central bank balance sheets remain at levels which make them THE dominant players, distorting the financial markets rather than merely facilitating those markets. Securities on their balance sheets now stand at $23 trillion, up from $4 trillion pre-crisis. The Federal Reserve began paying interest on bank excess reserves in a not so subtle effort to inject capital into banks and to fund its swollen balance sheet. Long after the crisis, it still pays market interest, thereby competing for private capital while quashing the intrabank Fed Funds market. Operation Twist was a specific program designed to lower long term rates relative to short term rates. Many of these OT securities remain on the Fed balance sheet, impacting the shape of the yield curve today. Quantitative Easing and Quantitative tightening are direct attempts by central banks to impact growth levels, still ongoing today, and are not a direct part of their mandate. Combined, these activities distort the important market signals that are necessary in robust markets. Central bank roles will come under close examination. The debate will be intense but healthy. Should central banks be limited to their "first principles" of currency stability and lender of last resort? Or should they proactively manage world economies? We expect a tilt back toward the former. Asset Managers overtake banks. Commercial banks have historically been the primary conduit through which depositors and borrowers clear the market. Most individuals and businesses maintain bank accounts to facilitate transactions and savings. Similarly, for individuals and all but the largest businesses, these banks are also the primary source of loans. Asset managers, on the other hand, provide investment management services primarily by deploying their investors’ capital via the secondary markets. That is abruptly changing in ways that are just beginning to emerge. We believe that over the next decade, asset managers will overtake banks as the primary financial institutions in both the retail and wholesale markets. Commercial banks, long the dominant market players, saw their competitive advantage sharply curtailed following the financial crisis. They became subject to SIFI supervision, Basel III’s liquidity requirements, tiered capital requirements and much more. Over the past ten years, total assets of the largest banks have been relatively flat. Asset managers not subject to these requirements, in particular the largest three companies, have grown enormously. The “Big 3” have nearly tripled in assets since the crisis and are now larger than the largest commercial banks. We expect that these supersized asset managers will be able to muscle into all aspects of the commercial banking franchise and radically alter the playing field. It is true that commercial banks enjoy the dual monopolies of deposit aggregation powers and payment settlement finality. However, technology will diminish those advantages (see below) to the point at which they cannot overcome their regulatory, capital and liquidity burdens. Deposit Banking diminishes in importance. The centuries-old deposit banking paradigm will not disappear anytime soon. But we believe it will radically change in the near future, creating significant winners and losers among financial and payments institutions. Deposits have long served two primary functions. They were a buffer to mitigate the uncertain clearing time for payments and they served as a repository for savings on the part of individuals who did not have direct access to the institutional markets. Rates paid on transaction deposits were negligible but that was part of the offset for transaction costs. Rates paid on savings were more competitive but slightly below market, given that banks provided the only way for retail savers to earn any return at all. Even today, banks aggressively compete for deposits across most wholesale and retail segments. Yet we believe this model is about to change as the cross currents of technology and regulation play out. On the transaction front, with faster (instant) payments will come greater certainty, leading to what we refer to as “just-in-time money”. In this new world, the need for a buffer vanishes. Fintech solutions will fund these accounts as necessary and will deploy all excess funds into the money markets. On the savings front, technology is eliminating the friction and transaction costs that stood in the way of savers directly accessing the markets. On-line brokers and internet banks are just the tip of the iceberg. Further, traditional commercial banks are saddled with Basel III related capital, liquidity and stable funding requirements that further erode their competitiveness. Deposits were once the holy grail of banking. That is about the change. Deposit Insurance becomes universal. Government insurance for bank deposits is a common safety net worldwide. By insuring a set level of deposits, governments boost depositors’ faith in the banking system and encourage capital formation. Banks are assessed premiums by the insuring government agency. These premiums are generally passed along to depositors in the form of slightly lower rates or higher transaction costs. At the onset of the financial crisis, the U.S. Congress raised the coverage amount from $100,000 to $250,000 per depositor per institution, and that has not been rolled back during the recovery. Temporarily, the limit was removed altogether for non-interest-bearing accounts. Taking deposit insurance well beyond the safety net aspect, financial institutions and tech companies are partnering to expand coverage to all of a customer’s deposits. A depositor can place funds well above the $250,000 limit with a lead participant. A servicer will take that large deposit, break it into $250,000 units and place one unit each with other banks in their network. Some networks include over 1,000 banks, enabling a depositor to place up to $250 million in a single deposit and have the entire amount insured. While this might seem to be at odds with the spirit of deposit insurance, neither the FDIC nor Congress have taken steps to limit the rapid spread of these deposits that now exceed $1 trillion, one-eighth of the total insured deposit base. In fact, in 2018 Congress passed legislation that gave regulatory support to “reciprocal” deposits, a subset of these types of programs. Consider, then, the rapidly approaching scenario in which ALL deposits are insured and the resulting moral hazard. A thin layer of bank shareholder capital is the only source of market discipline. The government is on the hook for all losses. That asymmetry likely leads to outsized risk taking. Ultimately, the government will be forced to step in and de facto nationalize the banks. Bills have been introduced in Congress, most recently in 2018, to allow the US Postal Service to take deposits and make loans. This could be the logical conclusion of unlimited deposit insurance. If the government is bearing all the risks of the banking system, the logical conclusion is that it takes over the banking system. USPS banks could be the first step in that direction. Private Liquidity Funds emerge as a major asset class. Like private equity funds a few decades ago, which provided a way to circumvent public markets for long term capital, Private Liquidity Funds will circumvent the public markets to enable the efficient provision of liquidity to both investors and borrowers. Technology is enabling “just-in-time money” which will redefine “liquidity”. Sweep accounts are now available at low cost to most savers and investors. Funds can be fully invested right up to the day they are needed. Thanks to fintech advances, funds can be drawn down at precisely the time they are needed. At the same time, regulators in the U.S. and around the world have hamstrung money market funds that focus on private sector liquidity. In 2016, US regulators implemented regulations that reduced the viability of prime money market funds. Prime funds invested in commercial paper and other private sector debt instruments. Thus, both the providers and users of liquidity were penalized. The bulk of prime fund assets flowed into government and treasury funds and are no longer available to provide liquidity to businesses. Similar regulations are currently being implemented in Europe. Unfortunately, because of the dramatic scale-back of prime funds, the most efficient conduit between providers and users of liquidity has been significantly curtailed. The upshot will be an entirely new asset class. Some forward-thinking asset managers have already established the first funds of this breed. They are similar to the pre-regulation 2a-7 funds but are limited to institutional investors. However, we expect these to morph into an asset class that will ultimately look very different from the current funds (MMFs, SMAs and Ultra Short Bond Funds) and incorporate the redefined “liquidity” and facilitate just-in-time cash. Forty years ago, no one envisioned the current structure and transformative role of private equity funds. We believe a similar transformation is about to overtake the liquidity market. Technology disintermediates the intermediaries. Historically, banks and other financial intermediaries filled the information gap between suppliers of capital (depositors, investors) and users of capital. They also bridged the gap between risk takers and risk avoiders. Banks knew both sides of the trade and could comfortably stand between providers and users of capital who did not know each other. If a single bank did not know the counter party of a transaction, it could easily locate a correspondent bank that did. These intermediaries lowered the transaction costs and risks (friction) that separated borrowers from lenders. The result was the rapid global expansion of trade and commerce. Fintech is changing all that in five key ways: Technology is fast closing that information gap. It is putting more reliable and more up-to-date information in the hands of all the parties in any given transaction, reducing the need for an intermediary. Social networks such as LinkedIn and others allow buyers and sellers to connect and investigate each other directly. Peer-to-Peer networks and microfinance schemes bypass the financial intermediary entirely. Technology is powering broad based sweep programs that move excess funds out of even the smallest investor or depositor accounts, the intermediaries, and directly into the financial markets. Intelligent technologies, such as robo-advisors, use sophisticated algorithms to bypass the traditional channels. The upshot is that the intermediary role of financial institutions is being displaced. Truly immediate payments eclipse faster payments. Over the past several decades, payments have become faster, cheaper and more reliable. Checks used to take days in the mail and then days to clear once deposited. International funds transfers would pass through several banks, each taking a “lifting” fee as the funds slowly passed from originator to recipient. Fortunately, those days are over. Now, central banks, commercial banks and payment networks are all racing each other to make payments even speedier. This is all very good since timing delays in payments and the attendant information flows create risk and uncertainty as well as wreaking havoc with cash forecasts and liquidity cushions. In the US the Fed launched its Faster Payments task force with this statement: “The task force calls upon all stakeholders to seize this historic opportunity to realize the vision for a payment system in the United States that is faster, ubiquitous, broadly inclusive, safe, highly secure, and efficient by 2020.” Around the globe, the UK announced its Faster Payments Service in 2008. In 2017, the European Central Bank kicked off its TIPS program (TARGET Instant Payment Settlement) with the goal of “instant” payments 24/7 within the euro area. The Monetary Authority of Hong Kong launched the Faster Payments System initiative in 2018. No doubt, payments are becoming much faster, more secure and more universal. The benefits of these initiatives are immense. In faster payments, funds and information, however fast and efficient, must still flow between the originator, the originator’s payment processor and/or bank, a central bank, the recipient’s payment processor and/or bank before becoming settled funds in the recipients account with finality. Even the ECB, in its TIPS communique, defined instant payments as “a matter of seconds”. That is a huge improvement. However, as high-frequency traders and arbitrageurs know, “a matter of seconds” is an eternity in financial markets. We believe that there will be one more step beyond faster payments: truly immediate payments. These payments will settle instantly, anywhere, anytime. At present, it’s difficult to envision. Perhaps blockchain technology is providing us the first glimpse. This has the potential of eliminating the sequential process of moving money and information (however fast) among transactors, their intermediaries and their settlement network. Alternatively, the paradigm for instant payments might come from outside the industry. Consider this analogy with railroads. In the late 19th century, railroads competed with each other to provide faster, safer and cheaper options in moving both passengers and freight between two points. Yet, even in the heat of that competition, no one within the industry considered putting wings on rail cars. Ironically, most payment intermediaries today refer to their networks as “rails”. 20th century institutions and structures are realigned. Post-WWII, late 20th century institutions and structures are unraveling. But, because they are so ingrained in our psyche, these shifts seem incomprehensible. The magnitude and scope of their impact are difficult to assess. But we believe that this is a megatrend impacting Treasury, Money and Banking. Trade organizations and trade agreements are coming apart or are being realigned in material ways. To see just a few underway right now, look no farther than the Pacific trade agreements, NAFTA and the EU with Brexit. Countries are subtly shifting to bi-lateral rather than multi-lateral constructs. Structures are also giving way. SWIFT is caught in a tug of war between its nominal role as a funds transfer communication system and its externally imposed role of sanctions enforcer. LIBOR, the reference rate for several trillion dollars of actual debt and hundreds of trillions of dollars of derivatives is phasing out within the next two years. The financial world needs to be repapered! Government-Sponsored Enterprises (GSEs) are coming under scrutiny. Agencies such as Fannie Mae and Freddie Mac that provide government guarantees in order to meet a “social good” took shape following the early 20th century’s great depression. They have now grown into behemoths, and some lay the blame of the 2008 financial crisis at the doorstep of the housing GSEs. Although governments decried the size of these agencies and vowed to trim then, they have continued to grow since the crisis. Paradoxically, central banks need GSE to create the instruments that now sit on their swollen balance sheets. We believe that many of these agencies will be downsized over time. The 20th century financial and geopolitical world is changing, and all market participants must adapt. Currency takes on a new role. This megatrend is counter-intuitive, but the data are clear. For decades, we’ve heard that we’re moving toward a cashless society. One with everything on a card or in a chip. Not so. The evidence is that, over the last decade, currency in circulation as a percentage of GDP has nearly doubled worldwide. In the US, currency increased from $800 billion in 2006 to $1.7 trillion in late 2018. That’s hardly a cashless society. (Scandinavia is an exception we need to explore.) Central banks and academia are beginning to study this phenomenon. Some key hypotheses about factors contributing to this are currently being formulated. They include: Convenience – It’s easy to transact in cash. Low holding cost – In an ultra-low interest rate environment, cash is cheap. Privacy – Currency transactions (and barter) are the only types of economic activity that don’t inherently require a corresponding exchange of data. Historically, currency has defined the underground economy. We now see an emerging role for currency in the above-ground economy for market participants desiring and valuing privacy or anonymity. Store of Value – In negative interest rate environments we see in some parts of the world, there is actually an economic benefit to holding currency in order to retain value. More interestingly, in certain low interest rate environments, the low carrying costs, to many, seem like a small price to pay to hedge political or economic uncertainty. India is a fascinating case study in progress. In November 2016, India eliminated large denominated rupee notes that represented 86% of India’s currency. Citizens had the opportunity to exchange the notes for smaller denomination notes. The intent was to root out the underground economy and raise tax revenue. The ramifications were far reaching and still playing out. But Bloomberg offers one interesting conclusion: “Cash remains the most popular form of tender in India. Currency with the public has increased to 18.5 trillion rupees in August 2018 from 17.9 trillion rupees before demonetization.” That is a 3% increase in currency in spite of an 86% drop in large denominated notes! Again, economists at present are trying to understand the factors behind this trend. Obviously, however, this creates a nightmare for regulators and those managing monetary policy. The trend is both real and “Mega”. Alternative currencies gain acceptance. This megatrend challenges the definition of money itself – the gaining acceptance of alternative currencies including crypto currencies. In ancient times, post-barter, precious commodities were the prevailing instrument of exchange and store of value. These commodities had intrinsic value that resulted in their reliability and acceptance. The middle ages saw the emergence of fiat currencies. They had value because a government said they had value. The problem with pre-modern fiat currencies is that they could be easily debased. A ruling body could simply turn on the printing press. Current fiat currencies such as the dollar, euro, pound, etc. are much more stable than their predecessors. That’s because they are issued and backed by the full faith and credit of sovereign governments. They are managed with a “goal” of price stability by central banks. The track record is far from perfect and debasement examples abound, but it is certainly improved. Crypto technologies are now enabling a new genre of fiat currency: crypto currencies like bitcoin and others. They are not the product of precious metals or scarce commodities. They are not issued by governments (yet). They are not “full faith and credit” instruments. They are not managed by central backs. Proponents insist that this litany of “they are nots” is actually a benefit, not a shortcoming. Following the Subjective Theory of Value, crypto currencies have value because buyers and sellers believe they have value. They are fiat currencies without governments or central banks. Adherents argue that frees them from manipulation by governments or central banks and creates a universal value. Air-BnB, Uber and Lyft offer instructive examples. After all, who would invite a total stranger to spend a night in their homes or jump into a stranger’s car. A key thing these companies provide to the gig economy is a decentralized mechanism of trust (in contrast to the trusted “central” bank). In doing so, they have transformed industries. This could be the trajectory of certain crypto currencies. We believe that some alternative currencies will become mainstream. While they might not be both a universal store of value and medium of exchange, some might take hold as settlement vehicles for specific types of payments. Others, because of their distributed processing security, could be liquidity vehicles. Still others, because of their global nature, could eliminate the need for foreign exchange in global trade. We’ll explore the profound implication in later megatrend articles. Solutions for the underbanked take shape. 30% of the world’s population do not have bank accounts. Many more do not have access to a basic set of banking services. They must either transact in cash, barter or use third party payment services, which tend to be very expensive. Check cashing services, payday lending, money orders, money transfer services, etc. provide the underbanked with some ability to make payments, but at a high cost. The economic impact is significant. In addition to the direct cost that the underbanked pay to access the financial system, there is an even greater cost in terms of lost economic activity. The inability to easily transact reduces the level of transactions and depresses commerce and trade. Fortunately, new technologies could provide economically viable solutions for the underbanked in the three most critical financial functions: Payment system access – Currently, people and businesses need a bank account to initiate or receive payments. Solutions developed by payments intermediaries and enabled by blockchain will provide the underbanked with payment services, conceivably bypassing the banking system altogether. Store of value – Blockchain could become the system of record for certain types of financial assets. This promises to allow the underbanked to safely and securely accumulate financial assets without having bank accounts. Assets could even be denominated in traditional central bank currencies or in crypto currencies. Access to capital – Peer to peer lending and micro finance are already providing non-traditional access to capital for the underbanked. Technology will accelerate this trend and make these services available to a larger population. Bringing the underbanked into the mainstream of the world’s economies creates opportunities that are difficult to fully appreciate. Increased economic activity, improved standards of living, expansion of markets are just some of the benefits that await. In Conclusion , this paper has presented eleven megatrends impacting treasury, money and banking on a global scale. Some of these trends are natural extensions of technological innovation, others are regulatory work-arounds or the result of geopolitical forces well beyond the control of any single jurisdiction. The Carfang Group believes that each of these megatrends, individually, are transformational and collectively point to a potential radical change to the financial system. Future articles will consider each of these megatrends in greater depth. We welcome your feedback as we embark of this exploration. About the author: Anthony J. Carfang is Managing Director of The Carfang Group and has a distinguished background in consulting, writing, speaking, thought leadership and advocacy in the area of treasury, payments and liquidity. He encourages you to provide feedback on this article or any other issues to tony_carfang@carfang.com . You can follow Tony at https://www.linkedin.com/in/carfang/ © 2019 The Carfang Group, LLC. All rights reserved.

Cómo apoyar a alguien con cáncer puede ser una tarea abrumadora. Saber qué decirle a alguien con cáncer o cómo apoyarlo puede ser difícil. Esta es la guía definitiva para el cuidado que apoya al cuidador y permite que esa persona sea lo mejor posible para apoyar a un ser querido, cónyuge y amigo. Salud Física Salud Mental Arteterapia Podcast More Te acaban de diagnosticar... Aprende de nuestros cuidadores cómo tu familia, amigos y compañeros de trabajo pueden apoyarte. Una guía para Cuidadores de personas Diagnósticadas con Cáncer de Mama Escucha las voces que nos inspiran a seguir adelante... ¿Eres un cuidador o cuidadora? Comparte tu Historia con nosotros! Historia de William Introducción En medio de un agradable y soleado paseo de finales de verano por las playas de Boston, mi pareja, que llevaba doce meses en tratamiento por cáncer de mama, me miró y me dijo: “Este ha sido el peor año de mi vida”. Mi respuesta fue inmediata: “Estoy en total desacuerdo, siento que este ha sido el el mejor año de tu vida”. Me miró como si tuviera dos cabezas y me preguntó a qué me refería. Elaboré mi respuesta con una sonrisa pensativa, “Acabas de vencer al cáncer de mama”. Esta conversación resumió acertadamente mi papel como cuidadora del cáncer de mama. Características del cuidado Hay muchas características de la vida como cuidador. El apoyo que se brinda a un paciente/sobreviviente de cáncer incluye muchos de los siguientes: aspectos emocionales, físicos, intelectuales, financieros, sociales, espirituales, nutricionales y motivacionales, por nombrar solo algunos. Pero nunca estás solo. Hay ayuda y asistencia en todas partes. A continuación hay 2 artículos que pueden servirte de guía para ser un cuidador. Después del Diagnóstico: Una guía para pacientes y sus familias Bienestar para los cuidadores Desde el momento del diagnóstico en adelante, entran en juego las responsabilidades asociadas con el cuidado. Hay reuniones y discusiones con sus equipos oncológicos y quirúrgicos. Se ofrecen y ponderan opciones y cursos de acción alternativos. Las decisiones deben tomarse en poco tiempo, por lo que es mejor prepararse con anticipación realizando la mayor diligencia posible. Investigar sobre las diversas opciones según lo explicado por tu equipo de atención. Una vez que se acuerde y planifique un curso de acción, ten especial cuidado de mantenerte al tanto de los desarrollos, es decir, citas programadas, manejo del dolor/emocional, medicamentos, coordinación y comunicación de la información a la familia de cuidado extendida y ayuda con las tareas del hogar. En todo momento, ten en cuenta que estás allí para ayudar al paciente. Esto no se trata de ti. Involúcrate en los problemas emocionales del paciente. No es necesario ser un profesional médico hay que tener sentido común y brindar nuestra respuesta a través de la lente del cuidado, es así como deben brindarle las herramientas suficientes para lidiar con la miríada de emociones que surgen, como el miedo y la depresión/tristeza. Hay muchos grupos de apoyo a los que puedes comunicarte, incluidos grupos de atención hospitalaria, psiquiatras, páginas de redes sociales/medios. SurvivingBreastCancer.org #survivingbreastcancer La perspectiva social Juntos nos arriesgamos e informamos a todos nuestros amigos, tanto en persona como a través de las redes sociales, del diagnóstico. También lo discutimos con el personal de nuestro restaurante del área local y en círculos de trabajo en la YMCA, para eliminar cualquier temor de consideraciones/comunicaciones de amigos y asociados con respecto a su cáncer. Recuerda, el paciente pasará por cambios tanto emocionales como físicos, pero aún querrá reanudar actividades placenteras como citas nocturnas o caminar en la caminadora tanto como sea posible. Descubrimos que la discusión abrió muchas puertas de bondad, amistad y solidaridad. Largo Plazo El remedio y el tratamiento del cáncer de mama es un compromiso a largo plazo. Debes ser consciente del hecho de que tu también, como cuidador, necesitas ayuda y apoyo, y también tiempo de calidad. No intentes hacerlo todo. Involucra a otros, ya sea familiares, amigos o incluso grupos de apoyo médico. Mantente flexible. Debido a la naturaleza cambiante y constante de la recuperación, desde la quimioterapia hasta la cirugía, la radiación, la quimioterapia adicional (si es necesaria) y los tratamientos hormonales de seguimiento, es posible que te enfrentes a múltiples facetas en los pacientes. Los efectos secundarios del tratamiento son variados e incluyen pérdida de cabello, aumento de peso por agua, alteración física de los senos, depresión, agotamiento, linfedema, problemas de fiebre aftosa, entre otros. Prepárate lo mejor que puedas para evitar que lo anterior te afecte negativamente en tu función. Está bien que el paciente esté cansado y triste. También está bien para el cuidador. Encontré que la comedia y la música (películas, televisión, radio) son un gran alivio, ya que tienden a cambiar la narrativa. Fomentar el Optimismo, Evitar la Negatividad Una última anécdota: en medio de un momento particularmente deprimente, le sugerí que fuéramos a dar un paseo en bicicleta para sacarla de su entorno. Como de costumbre, fuimos demasiado lejos (40 millas en total ese día) y su depresión estaba surgiendo. Así que aproximadamente treinta millas de nuestro viaje nos detuvimos y tomamos un descanso. Después de rehidratarnos y cargar combustible, pudimos levantarnos y regresar las últimas 10 millas a nuestro condominio en Boston. Meses después, me preguntó cómo pude ayudarla a superar su depresión severa y aterradora en ese viaje en particular. Me dijo que sus pensamientos bordeaban la realización de acciones irracionales. Le dije que permanecí enfocado en lo positivo y que no le ofrecí ninguna justificación psicológica para lidiar con su tristeza extrema y su comportamiento potencialmente dañino. Luego me preguntó “cómo supiste cómo responder” y mi respuesta fue simplemente reafirmar los aspectos saludables y positivos de nuestras vidas, lo que siempre nos devuelve a nuestro código en tiempos de problemas: Seguir Adelante. Cierre - Manejo de expectativas Para terminar, me gustaría sugerir que como cuidador permanezcas enfocado en el trabajo que tienes entre manos y manejes las expectativas. No intentes hacer demasiado. Reconoce lo que puedes hacer, investiga debidamente para que puedas ayudar en la discusión y la toma de decisiones. Mantente positivo e inspirado y tan útil sea posible. Pero recuerda que es un largo recorrido y que tu y tu paciente deberán contar entre ustedes durante la terrible experiencia. SUSCRÍBETE Nuestro boletín semanal incluye historias e información importante, tenemos varios eventos gratuitos para ti. Suscribete

Únete a la comunidad ¡Únete al boletín! Ten acceso a foros de discusión, noticias e información privilegiada Sanando a través del Arte Un diagnóstico de cáncer puede manifestar nuestros miedos más profundos, y mientras transitamos por esta experiencia que altera la vida, a menudo perdemos el contacto con el momento presente. A través del arte, la escritura y otras modalidades creativas, tenemos el poder de gestionar nuestro estrés, dar sentido a nuestro ahora y relajarnos en momentos de estrés. Exprésate, desahógate, conéctate con los demás y recupera el aliento. RSVP Grupo de Apoyo Un espacio para sanar en comunidad

Bienvenidos a Conversaciones sobre cáncer de mama: “Después de un Diagnóstico”. Mi nombre es Brenda Coronado. Y mi nombre es Lourdes Heras, somos sobrevivientes de cáncer de mama y Co-Fundadoras de SBC para la comunidad de habla Hispana, una organización sin fines de lucro que brinda apoyo en una plataforma virtual y educativa con el propósito de brindar grupos de apoyo y recursos para las personas diagnosticadas con cáncer y para sus seres queridos desde el primer día Después de un Diagnóstico. Después de un Diagnóstico Hola, y bienvenidos a Conversaciones sobre cáncer de mama: “Después de un Diagnóstico”; un podcast presentado por survivingbreastcancer.org. Mi nombre es Brenda Coronado. Y mi nombre es Lourdes Heras, somos sobrevivientes de cáncer de mama y Co-Fundadoras de SBC para la comunidad de habla Hispana, una organización sin fines de lucro que brinda apoyo en una plataforma virtual y educativa con el propósito de brindar grupos de apoyo y recursos para las personas diagnosticadas con cáncer y para sus seres queridos desde el primer día Después de un Diagnóstico. Salud Física Salud Mental Arteterapia Podcast More Download the App / Subscribe For Those Newly Diagnosed / For Those Living with MBC / For Families / For Caregivers Todos tenemos algo que contar, si has sido diagnosticada y quieres compartir tu historia, si eres un médico especialista, oncólogo u otro Participa ¿Quieres ser invitado al podcast?

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Acerca de Surviving Breast Cancer SU-PER-VI-VIEN-TE Si has sido diagnosticado con cáncer de mama. ¡Eres un Superviviente! Nuestra Historia Surviving Breast Cancer tiene sus raíces en Boston, MA con el fin de llenar un vacío en cuanto al apoyo, educación y recursos sobre cáncer de mama, fue fundado por una joven mujer en el 2017, Surviving Breast Cancer sirve de apoyo a aquellos diagnosticados, sus cuidadores y familias a nivel global. Aprovechando la tecnología y rompiendo las barreras para acceder a la información, Surviving Breast Cancer pone en primer lugar a las personas, escucha sus necesidades y crea programas, servicios, y contenido educativo basado en las necesidades de la comunidad de sobrevivientes con cáncer de mama. Seguimos creciendo y evolucionando constantemente ¡Amamos lo que hacemos por nuestra comunidad cada día! Nuestro enfoque SBC es una plataforma educativa y comunidad virtual que ofrece apoyo y soporte a los pacientes y sus familias en la etapa en la que se encuentren tras el diagnóstico de cáncer. Combinamos la investigación médica basada en la evidencia con las experiencias personales vividas por las personas a las que servimos. Desde las estrategias de reducción del riesgo y la prevención, hasta el tratamiento, la supervivencia, la vida con un diagnóstico terminal, la navegación por el final de la vida, y más allá, Surviving Breast Cancer está aquí para usted en cada paso del camino. SBC es una plataforma educativa y comunidad virtual que ofrece apoyo y soporte a los pacientes y sus familias en la etapa en la que se encuentren tras el diagnóstico de cáncer. Combinamos la investigación médica comprobable con las experiencias personales vividas por las personas a las que servimos. Desde las estrategias de reducción del riesgo y la prevención, hasta el tratamiento, la supervivencia, la vida con un diagnóstico terminal, transitar por el final de la vida, y más allá, Surviving Breast Cancer está aquí para ti en cada paso. Nuestros valores Creemos en la Colaboración Cuidamos a nuestra Comunidad Colaboramos con Asociaciones que Aportan Valor y Generan Impacto Lideramos con integridad Servimos con Compasión y Empatía Las Personas Primero Tratamos a todos con Dignidad y Respeto Estamos a la vanguardia A quién servimos El cáncer de mama no solo afecta a la paciente; afecta a todos a su alrededor. Es por eso que desarrollamos programas, servicios y educación integrales para satisfacer las necesidades de: Los diagnosticados con cáncer de mama Las que viven con cáncer de mama metastásico Cónyuges, familias e hijos que cuidan a un ser querido diagnosticado con cáncer de mama Cónyuges, familias e hijos que han perdido a un ser querido por cáncer de mama Empoderar a las personas diagnosticadas con cáncer de mama y a sus familias desde el primer día y durante el resto del proceso. Nuestra Misión Conoce a nuestro equipo, socios y colaboradores SBC se asocia con defensores de pacientes, oncólogos médicos, médicos y expertos en el campo, así como con corporaciones y organizaciones, para ofrecer la mejor educación, apoyo y recursos comunitarios para que podamos ejecutar nuestra misión. Conoce a nuestros socios Aprende sobre nuestro colaboradores Conoce nuestro equipo Salud Física Salud Mental Arteterapia Podcast More Download the App / Subscribe For Those Newly Diagnosed / For Those Living with MBC / For Families / For Caregivers

Historias inspiradoras sobre el cáncer de mama El diagnóstico de cáncer de mama de cada persona es diferente. Cada persona responde de forma diferente al tratamiento. Cada persona toma decisiones diferentes en función de sus preferencias y circunstancias personales. No hay nada bueno ni malo. Sólo experiencias. Somos expertos en nuestra propia experiencia. A continuación encontrará muchas historias inspiradoras, entre las que se incluyen: Comparte tu historia Comparte tu Historia Compartir tu historia es importante ya que exploraras por medio de la escritura esas anécdotas, desafíos y logros después de un diagnóstico, y al mismo tiempo motivas e inspiras a otras personas de esta comunidad. Explora

Breast Density Are You Breast Dense Aware? What Is Breast Density Dense breast tissue makes it harder for radiologists to see cancer. On mammograms, dense breast tissue looks white, and breast masses or tumors also look white. So, the dense tissue can hide tumors. In contrast, fatty tissue looks almost black. On a black background it’s easy to see a tumor that looks white. So, mammograms can be less accurate in women with dense breasts. Survivingbreastcancer.org acknowledges that the above video is sited from our friends at beingdense.com (@Breastdense). The video may not be reproduced without Beingdense.com's permission. The FDA has announced important new steps to modernize breast cancer screening and help empower patients with information when they are considering important decisions regarding their breast health care. Not all U.S. states are required to notify their patience as to whether or not they have dense breast. Is your state one of them? View Data What is breast density and how does it affect screenings? Watch Now How to advocate for additional screenings Watch Now Why is Understanding Breast Density Important? Having dense breast tissue might increase your risk of getting breast cancer. Women who have dense breast tissue have a slightly higher risk of breast cancer compared to women with less dense breast tissue. It’s unclear at this time why dense breast tissue is linked to breast cancer risk. We know there are many risk factors for breast cancer – starting menstrual periods early, late menopause, first pregnancy after age 30, family members with breast cancer – just to name a few. The 2 most important risk factors are being a woman and getting older. Women who have a strong family history of breast cancer or the breast cancer genes (BRCA1 or BRCA2) are at high risk for breast cancer. Women at high risk should have MRIs each year along with their mammograms. Women with dense breast tissue are at moderate risk for breast cancer. MRIs are not recommended for women at moderate risk for breast cancer based on what’s known today. What is Dense Breast Tissue? Breasts are made up of lobules, ducts, and fatty and fibrous connective tissue. • Lobules produce milk and are often called “glandular tissue.” • Ducts are the tiny tubes that carry milk from the lobules to the nipple. • Fibrous tissue and fat give breasts their size and shape and hold the other tissues in place. Your breasts will be seen as dense if you have a lot of fibrous or glandular tissue and not much fat in the breasts. Some women have more dense breast tissue than others. For most women, breasts become less dense with age. But in some women, there’s little change. Breast density is very common, and is not abnormal. How do I know if I have Dense Breasts? Breast density is seen only on mammograms. Some women think that because their breasts are firm, they are dense. But breast density isn’t based on how your breasts feel. It’s not related to breast size or firmness. Radiologists are the doctors who “read” x-rays like mammograms. They check your mammogram for abnormal areas, and also look at breast density. There are 4 categories of breast density. They go from almost all fatty tissue to extremely dense tissue with very little fat. The radiologist decides which of the 4 categories best describes how dense your breasts are. Some mammogram reports sent to women mention breast density. At one time, doctors assigned a number to the density category, but it’s now worded in a way that’s easier to understand. Women whose mammograms show anything more than scattered areas of dense tissue may be told that they have “dense breasts.” Breasts are almost all fatty tissue. There are scattered areas of dense More of the breast is made of dense glandular and fibrous tissue. glandular and fibrous tissue. This can make it hard to see small tumors in or around the dense tissue. Breasts are extremely dense, which makes it hard to see tumors in the tissue. Why is Breast Density Important? Having dense breast tissue might increase your risk of getting breast cancer. Women who have dense breast tissue have a slightly higher risk of breast cancer compared to women with less dense breast tissue. It’s unclear at this time why dense breast tissue is linked to breast cancer risk. We know there are many risk factors for breast cancer – starting menstrual periods early, late menopause, first pregnancy after age 30, family members with breast cancer – just to name a few. The 2 most important risk factors are being a woman and getting older. Women who have a strong family history of breast cancer or the breast cancer genes (BRCA1 or BRCA2) are at high risk for breast cancer. Women at high risk should have MRIs each year along with their mammograms. Women with dense breast tissue are at moderate risk for breast cancer. MRIs are not recommended for women at moderate risk for breast cancer based on what’s known today. If I Have Dense Breasts, Do I Still Need a Mammogram? Yes. Most breast cancers can be seen on a mammogram even in women who have dense breast tissue. So, it’s still important to get regular mammograms. Mammograms can help save women’s lives. Even with a normal mammogram report, a woman should know how her breasts normally look and feel. Anytime there’s a change, she should report it to her health care provider right away. What should I do if I have dense breast tissue? If your mammogram report says that you have dense breast tissue, talk with your provider about what that means for you. Be sure that your doctor or nurse knows your medical history and whether there’s anything in your history that increases your risk for getting breast cancer. Any woman who’s already in a high-risk group (based on gene mutations, a strong family history of breast cancer, or other factors) should have an MRI along with her yearly mammogram.

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Exercise has a number of biological effects on the body, including lowering the levels of hormones, such as estrogen, and of certain growth factors that have been associated with cancer development and progression helping to prevent obesity and decreasing the harmful effects of obesity Walking Meditation Building Strength Salud Física Salud Mental Arteterapia Podcast More Fitness Tips for Breast Cancer Survivors (& their Caregivers) It is well documented that physically active women have a lower risk of breast cancer than do others who are not. Thus, it stands to reason that physically active breast cancer survivors may reduce the risk of cancer’s return, and dramatically improve quality of life. As always, consult your oncological team before starting out on your fitness program. According to Breastcancer.org, exercise can lower your risk of breast cancer coming back, as well as help you maintain a healthy weight, ease treatment side effects, boost your energy, and more! Exercise Is Safe Per Breastcancer.org (one of the attached links below), “a roundtable convened by the American College of Sports Medicine in 2010 reviewed available research and concluded that exercise is safe during and after all breast cancer treatments (as long as you take any needed precautions and keep the intensity low) and improves physical functioning, quality of life, and cancer-related fatigue. There also is evidence that exercise can help breast cancer survivors live longer and lead a more active life.” Risk Reduction According to Cancer.gov (link below) “studies show that physically active women have a lower risk of breast cancer than inactive women. Physical activity has been associated with a reduced risk of breast cancer in both premenopausal and postmenopausal women; however, the evidence for an association is stronger for postmenopausal breast cancer.” This study further elaborates on how exercise can reduce the risks of cancer, and, or its return: Exercise has a number of biological effects on the body, including: Lowering the levels of hormones , such as estrogen , and of certain growth factors that have been associated with cancer development and progression Helping to prevent obesity and decreasing the harmful effects of obesity Reducing inflammation Improving immune system function Cognitive Impairment (“chemo brain”) Furthermore, a new study (found in the Sciencedaily.com link below) “indicates that cancer patients and survivors have a ready weapon against fatigue and "chemo brain": a brisk walk. Their data suggests “that being more physically active could reduce two of the more commonly reported symptoms in breast cancer survivors: fatigue and cognitive impairment". Cognitive impairment, such as memory problems or shortened attention spans, is a common complaint among cancer patients and survivors, and is thought to be similar to decline due to aging. Fitness Recommendations With the above (and below) referenced studies in mind, we at Survivingbreastcancer.org are recommending the following exercise possibilities: Walking The health effects of a brisk walk cannot be overstated, notably for cognitive impairment, but also for muscular and circulatory systems. Yoga This discipline combines stretching, deep breathing, toning of the muscular system and offers a wonderful way to relax the nervous system. Meditation According to the Laura-Sage (link below), meditation can effectively reduce stress, anxiety, depression, fatigue, and fear of recurrence. It can also help reduce hot flashes. Weight Resistance & Training Program In another recent study study, researchers looked at data from the Physical Activity and Lymphedema (PAL) trial to determine whether slowly increased weight lifting could increase muscle strength among breast cancer survivors and help them avoid frailty and maintain physical function. Aerobic and Cardio Training (swimming, running, elliptical, stairmaster, etc.) Lastly, another recent study (for the NIH) showed that a “10 week moderate-intensity aerobic exercise program significantly improves quality of life and physical functioning in breast cancer survivors.” Please note that further long-term studies have been recommended Related Articles Check back soon Once posts are published, you’ll see them here. Additional Resources We found the following links to be beneficial: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet https://www.scribd.com/document/268275865/Breast-cancer-and-physical-activity https://www.acefitness.org/education-and-resources/lifestyle/blog/6753/exercise-for-breast-cancer-survivors https://www.sciencedaily.com/releases/2017/07/170725122242.htm https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm#ReduceCancer https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/physical-activity-and-the-cancer-patient.html http://www.breastcancer.org/tips/exercise https://community.breastcancer.org/forum/44/topics/836196 http://www.lbbc.org/building-and-restoring-physical-fitness-after-breast-cancer https://www.mindbodygreen.com/articles/what-you-need-to-know-about-exericse-and-cancer https://www.huffingtonpost.com/laura-sage/5-benefits-of-meditation_b_10617412.html https://www.cancer.org/.../study-weight-lifting-helps-breast-cancer-survivors-stay-health ... https://www.ncbi.nlm.nih.gov/pubmed/25313756

Salud Física Salud Mental Arteterapia Podcast More Resources For Children & Adolescents It was at a breast cancer walk just a few weeks later, with thousands of people, when I realized the need for #pinkkids. Of all the walkers, more than half were kids. I knew then I wasn’t alone. I knew we needed to connect with each others and #pinkkids is the place for that connection. We are starting by sharing stories on the blog and through podcasts, as well as a private Group (link below). We’ll keep you up to date through SBC emails, as well as our Instagram (_pinkkids_). Looking forward to talking! Do you have a mom or dad who has been diagnosed with breast cancer? Or perhaps you have lost a parent to MBC? Connect with Kyla, share your story, post your why, or just let her know how you are doing today, we're all here to listen, support, and be a resource! Email Kyla at pinkkids@survivingbreastcancer.org My name is Kyla Thompson, and I welcome you, kids, like me, to our space! My mom passed away of metastatic breast when I was 13. She was first diagnosed when I was two years old. I didn't know what breast cancer was then. 11years later, on October 21, 2014, a world that was filled with sports, homework, friends, and more shifted in a few seconds. My mom was gone. Read Stories Share your story. Share Your Why. Share A picture. Share. Email Kyla at pinkkids@survivingbreastcancer.org

Genetic testing can lead to important outcomes that help inform surgery decisions. Lymphedema What is the Lymphatic System? Our bodies have a network of lymph nodes and lymph vessels. This system collects and carries a watery, clear lymph fluid, much like how veins collect blood from distant parts of the body and carry it back to the heart. This fluid consists of proteins, salts, and water, as well as white blood cells, which help fight infection. What Is Lymphedema? Lymphedema is most commonly caused by the removal of, or damage to, your lymph nodes as a part of cancer treatments. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling. According to the National Cancer Institute, anywhere from 5-17% of women who have sentinel lymph node biopsy develop lymphedema. Among women who have axillary lymph node dissection, the percentage is higher — from 20-53% — and the risk increases with the number of nodes taken out. Not surprisingly the risk is even higher if you receive radiation to the breast, chest, and under the arm area. Lymphedema is the build up of lymph fluid within the lymphatic system. The buildup can be caused by a number of factors which we will get into below. Lymphedema can occur in the limbs and extremity such as the arms and legs. As it relates to breast cancer, the most common occurrence of lymphedema occurs in the arm, chest, or back. Lymphedema is something that can be managed so you never get it, or, it is something you manage on a continual basis to avoid flareups and progression as there is no cure for lymphedema. Although there is no official cure, there are plenty of beneficial treatment plans that help mitigate side effects. How To Prevent Lymphemdema After Surgery, your surgeon may recommend specific exercises to increase mobility and prevent lymphedema. They may also recommend seeing a physical therapist. With approval of your medical care team (and feel free to ask them!) you may start exercises to prevent cording. Cording, which is also known as axillary web syndrome (AWS) which refers to a long line of "cord" that develops under the armpit and axilla area and can happen after someone undergoes a sentinel lymph node biopsy (SLNB) or a full axillary lymph node dissection (ALND). One of the most common exercises to prevent cording and/or axillary web syndrome is the activity of "walking the walk". This is an excellent exercise: 1. Stand perpendicular to the wall 2. With the affected arm, using your fingers to start crawling up the wall (think itsy bitsy spider). 3. As your arm makes it way up the wall, lean in to the highest point you are able to achieve without causing harm or pain, and hold for 10 seconds. Repeat this process several times throughout the day. Your doctor may also recommend specific exercises utilizing weights and limits on the number of pounds or kilos you should lift. It's always better to start off light, never over do it, and increase weight slowly and gradually, over time. 10 Recommendations To Prevent Lymphedema: Avoid tight clothing and jewelry on the arm and wrists Avoid cutting your cuticles Use insect repellent when outdoors Avoid sunburn and excessive amounts of heat from saunas and baths Avoid having IV's or blood pressure taken in the at-risk arm. Wear a compression sleeve when traveling on air planes or carrying a lot of heavy luggage. Keep your arm elevated whenever possible Engage in activities that help promote the movement of your lymph fluid such as yoga and swimming Nutrition plays an important role in life after a breast cancer diagnosis; maintain a healthy weight and a low sodium diet Carry handbags and purses on the unaffected arm Lymphedema 101 On Breast Cancer Conversations, the Podcast Listen Now

SurvivingBreastCancer.org lectura de 5 minutos Por Nora Herrera Guatemala Recuerdos de mi diagnóstico de cáncer de mama Cuando tenía 50 años, me estaba alistando para salir, me iba a bañar y vi que mi pecho se habia pegado a mi brasier, cuando me lo quite vi que tenia un líquido de color amarillo, no le di importancia, asi que seguí bañandome, días despues me junte con unas amigas que tenian la edad de mi mamá, ella había fallecido hace 10 años por un cáncer de mama que no fue tratado a tiempo, les conté lo que me estaba pasando y que en ese momento el pezón lo tenía hundido, mis amigas me dijeron que fuera a cancerologia inmediatamente. Yo siempre había ido a los médicos acompañada de mi mamá y estuve posponiendo y posponiendo, pero mis amigas me insistieron y hasta se ofrecieron a acompañarme. Fue entonces que me dije a mi misma, no puede ser que tenga 50 años y no pueda ir sola al médico. Me levanté temprano al siguiente día, envié a mi hijo al colegio, me subí al bus y llegué al INCAN (Instituto de Cancerología en Guatemala) había dos largas colas que atravesaban toda la sala de espera y más allá, pregunté cuál era la cola para los pacientes que iban por primera vez pero nadie sabía nada, así que me paré detrás de la cola de la izquierda, al llegar a la enfermera que atendía esa fila me dijo que no era allí y que había hecho cola en la fila que era para pagar. Entonces me mandaron a sentar en las bancas que estaban en una sala vacía, poco a poco llegaron otras personas, de repente una enfermera nos pregunta ¿qué hacen ahí sentados? Le dijimos que era primera vez que íbamos y que nos mandaron aquí, la enfermera nos dijo que todos los doctores se habían ido al hospital, pero nos dijo que iba a conseguir alguien que nos ayudara, cuando volvimos a ver a la enfermera venía con 3 doctores jóvenes, no se si eran doctores o practicantes pero con lo nerviosa que estaba dejé que todos los demás pasaran y me quedé de último. Al fin entré en la consulta, me senté en un banquito y los 3 doctores me veían como si fuera la acusada de algún delito, les explique lo que tenia, me sentí observada y al final me dieron un pedazo de cartón, me trataron muy mal y me dijeron que me fuera. Me sentía frustrada y enojada y me dije a mi misma que en el primer basurero que encontrara iba a tirar el cartón y me iba a regresar a mi casa, mi sorpresa fue que cuando sali la misma enfermera me estaba esperando y me pregunto si me habian dicho algo, le conteste que solo me dieron un pedazo de cartón, ella me dijo venga conmigo, al llegar tenía mucho miedo, pensé que me iban a lastimar los pechos como el último doctor, sin embargo el doctor me escucho y me examinó gentilmente, me dijo que sentia algo extraño y que tenia que hacerme exámenes, para eso me tenia que meter una aguja en el pezón, la verdad no senti nada de dolor, me dijo que regresara en 8 días para recoger las pruebas. Le conté a mi hermana Marina lo que había pasado y ella se encargó de contarselo al resto de mis hermanos, mi prima llegó a mi casa y me dijo que no me preocupara que ella se iba a encargar de cuidar a Pepito si era necesario y todos estuvieron pendientes de mí. A los 8 días llegué a mi cita y el doctor me dijo que tenía cáncer de mama y que tenían que operarme al día siguiente y que me tenía que quedar de una vez para hacerme los exámenes preoperatorios, no sé en qué estadio estaba, ni qué tipo de cáncer, no me informaron de nada sino hasta después. Cuando salí de la operación nos llevaron a un cuarto con otras 6 mujeres, eramos 3 jóvenes y 3 mayores como yo, fue muy bonito porque todas teníamos muy buen sentido del humor y pasamos bromeando y riéndonos, todos mis familiares me sorprendieron al visitarme, se llenó el cuarto de mis visitas ya que también llegaron mis amigas y estuvimos platicando y riéndonos, nunca tuve miedo, porque no supe que tenía cáncer sino hasta después de la cirugía, me hicieron una mastectomía completa del lado derecho, no tengo nada allí. Al salir del hospital me dijeron que tenía que seguir llegando, estuve con radioterapia todos los días, y luego revisiones anuales. Luego de unos años me di de alta yo misma y no he vuelto a tener ninguna recaída gracias a Dios. Le debo mi vida a mis amigas que hicieron que fuera a cancerología y a esa enfermera que no recuerdo su nombre pero que sin ella yo ya no estaría aquí. Ahora estoy por cumplir 79 años, vi crecer a mi hijo y a mis sobrinos, tengo una nieta y puedo decir que he disfrutado de la vida, de las personas que me rodean y de mi misma.

Breast Cancer Risk Factors Breast Cancer Risk and Risk Factors You may be familiar with the statistic that says 1 in 8 women will develop invasive breast cancer. Many people misinterpret this to mean that, on any given day, they and the women they know have a 1-in-8 risk of developing the disease. That’s simply not true. In reality, about 1 in 8 women in the United States — 12%, or about 12 out of every 100 — can expect to develop breast cancer over the course of an entire lifetime. In the U.S., an average lifetime is about 80 years. So, it’s more accurate to say that 1 in 8 women in the U.S. who reach the age of 80 can expect to develop breast cancer. In each decade of life, the risk of getting breast cancer is actually lower than 12% for most women. People tend to have very different ways of viewing risk. For you, a 1-in-8 lifetime risk may seem like a high likelihood of getting breast cancer. Or you may turn this around and reason that there is a 7-in-8, or 87.5%, chance you will never get breast cancer, even if you live to age 80. How you view risk often depends on your individual situation — for example, whether you or many women you know have had breast cancer, or you have reason to believe you are at higher-than-normal risk for the disease — and your usual way of looking at the world. Even though studies have found that women have a 12% lifetime risk of developing breast cancer, your individual risk may be higher or lower than that. Individual risk is affected by many different factors, such as family history, reproductive history, lifestyle, environment, and others. Breast Cancer Risk Factors A “risk factor” is anything that increases your risk of developing breast cancer. Many of the most important risk factors for breast cancer are beyond your control, such as age, family history, and medical history. However, there are some risk factors you can control, such as weight, physical activity, and alcohol consumption. Be sure to talk with your doctor about all of your possible risk factors for breast cancer. There may be steps you can take to lower your risk of breast cancer, and your doctor can help you come up with a plan. Your doctor also needs to be aware of any other risk factors beyond your control, so that he or she has an accurate understanding of your level of breast cancer risk. This can influence recommendations about breast cancer screening — what tests to have and when to start having them. Risk Factors You Can Control Weight . Being overweight is associated with increased risk of breast cancer, especially for women after menopause. Fat tissue is the body’s main source of estrogen after menopause, when the ovaries stop producing the hormone. Having more fat tissue means having higher estrogen levels, which can increase breast cancer risk. Diet . Studies are looking at the relationship between diet and breast cancer risk and the risk of recurrence. The Women's Health Initiative Trial suggested that a diet very low in fat may reduce the risk of breast cancer. More research is needed in this important area for women who are interested in eating well to reduce their risk of ever getting breast cancer. In the meantime, here's what dietitians suggest: • Keep your body weight in a healthy range for your height and frame. Body mass index , though not a perfect measurement, can help you estimate your healthy weight. • Eat plenty of vegetables and fruit (more than 5 cups a day). • Try to limit your saturated fat intake to less than 10% of your total calories per day and limit your fat intake to about 30 grams per day. • Eat foods high in omega-3 fatty acids . • Avoid trans fats, processed meats, and charred or smoked foods. You'll find that processed foods generally don't fit in this type of diet as well as fresh foods do. For more information, visit our page on healthy eating to reduce risk of breast cancer in the Nutrition section. Exercise . Evidence is growing that exercise can reduce breast cancer risk. The American Cancer Society recommends engaging in 45-60 minutes of physical exercise 5 or more days a week. (See our Fitness Guide) Alcohol consumption. Studies have shown that breast cancer risk increases with the amount of alcohol a woman drinks. Alcohol can limit your liver’s ability to control blood levels of the hormone estrogen, which in turn can increase risk. Smoking. Smoking is associated with a small increase in breast cancer risk. Exposure to estrogen. Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any breaks, can increase the risk of breast cancer. Some of these risk factors are under your control, such as: • taking combined hormone replacement therapy (estrogen and progesterone; HRT) for several years or more, or taking estrogen alone for more than 10 years • being overweight • regularly drinking alcohol Recent oral contraceptive use. Using oral contraceptives (birth control pills) appears to slightly increase a woman’s risk for breast cancer, but only for a limited period of time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk. Stress and anxiety. There is no clear proof that stress and anxiety can increase breast cancer risk. However, anything you can do to reduce your stress and to enhance your comfort, joy, and satisfaction can have a major effect on your quality of life. So-called “mindful measures” (such as meditation, yoga, visualization exercises, and prayer) may be valuable additions to your daily or weekly routine. Some research suggests that these practices can strengthen the immune system. (See our resources on Positive Thinking, Meditation and Affirmations ) Risk Factors You Cannot Control Gender. Being a woman is the most significant risk factor for developing breast cancer. Although men can get breast cancer, too, women’s breast cells are constantly changing and growing, mainly due to the activity of the female hormones estrogen and progesterone. This activity puts them at much greater risk for breast cancer. Age. Simply growing older is the second biggest risk factor for breast cancer. From age 30 to 39, the risk is 1 in 228, or .44%. That jumps to 1 in 29, or just under 3.5%, by the time you are in your 60s. Family history of breast cancer. If you have a first-degree relative (mother, daughter, sister) who has had breast cancer, or you have multiple relatives affected by breast or ovarian cancer (especially before they turned age 50), you could be at higher risk of getting breast cancer. Personal history of breast cancer. If you have already been diagnosed with breast cancer, your risk of developing it again, either in the same breast or the other breast, is higher than if you never had the disease. Race. White women are slightly more likely to develop breast cancer than are African American women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. Radiation therapy to the chest. Having radiation therapy to the chest area as a child or young adult as treatment for another cancer significantly increases breast cancer risk. The increase in risk seems to be highest if the radiation was given while the breasts were still developing (during the teen years). Breast cellular changes. Unusual changes in breast cells found during a breast biopsy (removal of suspicious tissue for examination under a microscope) can be a risk factor for developing breast cancer. These changes include overgrowth of cells (called hyperplasia) or abnormal (atypical) appearance. Exposure to estrogen. Because the female hormone estrogen stimulates breast cell growth, exposure to estrogen over long periods of time, without any breaks, can increase the risk of breast cancer. Some of these risk factors are not under your control, such as: • starting menstruation (monthly periods) at a young age (before age 12) • going through menopause (end of monthly cycles) at a late age (after 55) • exposure to estrogens in the environment (such as hormones in meat or pesticides such as DDT, which produce estrogen-like substances when broken down by the body) Pregnancy and breastfeeding. Pregnancy and breastfeeding reduce the overall number of menstrual cycles in a woman’s lifetime, and this appears to reduce future breast cancer risk. Women who have never had a full-term pregnancy, or had their first full-term pregnancy after age 30, have an increased risk of breast cancer. For women who do have children, breastfeeding may slightly lower their breast cancer risk, especially if they continue breastfeeding for 1 1/2 to 2 years. For many women, however, breastfeeding for this long is neither possible nor practical. DES exposure. Women who took a medication called diethylstilbestrol (DES), used to prevent miscarriage from the 1940s through the 1960s, have a slightly increased risk of breast cancer. Women whose mothers took DES during pregnancy may have a higher risk of breast cancer as well. What's the Difference between Diet and Nutrition? On Breast Cancer Conversations, the Podcast Listen Now

Meet Laura and learn about her journey with breast cancer. Diagnosis: I was diagnosed with Stage IIB breast cancer in the fall of 2016 at the age of 34. I've been through chemo-therapy : Adriamycin, Cytoxan, Taxol, Perjeta, Herceptin, Xeloda Surgery : Partial Mastectomy and full axillary node dissection. Radiation : 6 Weeks Hormonal Therapies: Tried Anastrozole, didn't react well to it so now I am on Exemestane + Lupron shot. And I am here to share my story! Laura's Journey Subscribe to my Vlog Day 1 post chemo My Port & My Hair Intravenous Chemo #3 Chemo #8 of 16 Morning Workout day of surgery Warning: Graphic Content - Drains Last round of Radiation, 30/30! Symptoms from Chemo (AC Treatment) Waking up from Surgery 4 Weeks Post-Op Round 1 of Xeloda Day 4 Post-Op Radiation, 3 Weeks In Round 8 of Xeloda Night Before Surgery Have questions or want to get in touch? Email Laura! Have a story you want to share? We want to hear from you! Submit a Story! Return Back to Survivor Stories

El diagnóstico de cáncer de mama de cada persona es diferente. Cada persona responde de forma diferente al tratamiento. Comparte TU HISTORIA Envíanos tu contenido HISTORIAS - BLOGS - POESÍA Formulario El diagnóstico de cáncer de mama de cada persona es diferente. Las personas responden de forma diferente al tratamiento e incluso toman decisiones diferentes en función de su situación personal. También entendemos que el cáncer de mama se extiende mucho más allá de la persona diagnosticada ya que afecta a todos los aspectos de la vida, incluidos los miembros de la familia, los amigos y los seres queridos. Compartir tu experiencia no sólo ayuda a otras personas que buscan una conexión, sino que también es terapéutico para ti. Desahogarte por todo lo que has pasado, expresar tus preocupaciones, preguntas, miedos, éxitos y celebraciones, puede ayudarte a dar sentido a la experiencia del cáncer. Además, muestra a los miembros de nuestra comunidad survivingbreastcancer.org que no están solos y que somos una poderosa comunidad de guerreros. ¿No sabes como empezar? Explora nuestras historias de supervivientes y luchadores contra el cáncer de mama aquí . También estamos creando recursos para madres, hijas, cónyuges y otros, así que asegúrate de visitarnos a menudo. Comparte tu historia, blog o artículo Nombre Apellido Email Enviar Sube tu documento o compartenos el link de Google Docs Sube tu foto aquí Sube tu artículo aquí Si quieres puedes compartir tu usuario en redes ¡Gracias por Compartir! ¿Necesitas ayuda con los temas y las ideas? Tenemos orientaciones y recomendaciones para empezar. Puedes encontrarlas debajo del formulario de presentación. ¿Qué información personal debo incluir en mi relato? Siéntete libre de compartir toda la información con la que te sientas cómodo. Piensa en el momento en que te diagnosticaron la enfermedad: ¿Qué información buscabas? ¿Qué te hubiera gustado saber? Algunas de las cosas que puedes compartir (pero que no son obligatorias) son: Edad del diagnóstico ¿Cuál fue tu diagnóstico (tipo, estadio)? ¿Te has sometido a quimioterapia y, en caso afirmativo, qué fármacos has tomado? ¿Te han operado? En caso afirmativo, ¿Qué tipo de operación, Cómo se hizo esa elección, y/o se vieron afectados los ganglios linfáticos? ¿Te has sometido a radiación? Si es así, ¿cuántas semanas? ¿Estuviste en alguna prueba experimental? ¿Cómo fue tu experiencia? ¿Estás tomando alguna terapia hormonal, y si es así, qué medicamentos? Siempre puedes incluir tu correo electrónico, si quieres que los supervivientes te envíen un correo y se pongan en contacto contigo directamente. Sólo utilizamos los nombres reales si te así lo deseas y siempre puedes indicarnos si prefieres el anonimato. ¿Qué temas debo contar en mi historia? Puedes compartir sobre una variedad de temas. Expresa como es o fue tu propia experiencia. Comparte temas que creas que pueden ser útiles para que otros los entiendan. Utiliza tu historia como medio de catarsis, para desahogarte y liberarte. Algunos ejemplos (pero no limitados a) incluyen: ¿Qué esperar de la quimioterapia? ¿Cómo gestionar la pérdida de cabello, consejos y recomendaciones? Entender los cambios corporales y cómo afrontarlos Salud y nutrición/hábitos alimenticios durante el tratamiento Combatir la fatiga y el "chemo brain" Gestionar el equilibrio entre el trabajo, el hogar y la vida, mientras estás en tratamiento Las 10 cosas que desearía saber antes de iniciar el tratamiento/la cirugía Un día en la vida de un superviviente... ¿Y si no me gusta escribir o llevar un diario? ¿Hay otras formas de compartir mi historia? ¡Por supuesto! Este es un espacio creativo y abierto para que los sobrevivientes y sus cuidadores compartan sus experiencias a través de una variedad de medios expresivos. Siéntete libre de compartir tu historia a través de un diario/escritura, poesía, música, arte, movimiento y más. ¡Comparte lo que tú quieras! Siempre puedes enviarnos imágenes para incluirlas con tu historia. Si quieres que te ayudemos a editar cualquier contenido, sólo tienes que decírnoslo. Estaremos encantados de ayudarte. ¿Y si quiero incluir fotos o actualizar mi historia más adelante? No hay problema. Sólo tienes que ponerte en contacto con nosotros y podremos añadir fotos y hacer actualizaciones en cualquier momento.

Noticias sobre el cáncer, historias y más

Salud Física Salud Mental Arteterapia Podcast More Vida Saludable La salud y la nutrición son una parte muy importante para tu cuerpo. Los complementos adecuados de los alimentos te permiten alcanzar un rendimiento óptimo y sentirte lo mejor posible. "Que la comida sea tu medicina y la medicina tu alimento" Regístrate Nuestro boletín semanal incluye historias e información importante, tenemos varios eventos gratuitos para ti. Eventos Boletín Introducción al bordado El bordado es una forma de arte decorativa que utiliza telas, agujas e hilos diseñados para agregar textura y adornos.

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop. What the risk factors are, understanding the symptoms of breast cancer, how to screen for breast cancer, the types of breast cancer and staging. Cáncer de mama ¿Qué es el cáncer de mama? El cáncer de mama es un crecimiento descontrolado de las células mamarias. Para comprender mejor el cáncer de mama, es útil entender cómo se puede desarrollar cualquier tipo de cáncer. El cáncer se produce como resultado de mutaciones o cambios anormales en los genes responsables de regular el crecimiento de las células y mantenerlas sanas. Los genes están en el núcleo de cada célula, que actúa como la "sala de control" de cada célula. Normalmente, las células de nuestro cuerpo se reemplazan a sí mismas a través de un proceso ordenado de crecimiento celular: nuevas células sanas toman el relevo a medida que mueren las viejas. Pero con el tiempo, las mutaciones pueden “activar” ciertos genes y “desactivar” otros en una célula. Esa célula cambiada adquiere la capacidad de seguir dividiéndose sin control ni orden, produciendo más células iguales y formando un tumor. Un tumor puede ser benigno (no peligroso para la salud) o maligno (tiene el potencial de ser peligroso). Los tumores benignos no se consideran cancerosos: sus células tienen una apariencia casi normal, crecen lentamente y no invaden los tejidos cercanos ni se diseminan a otras partes del cuerpo. Los tumores malignos son cancerosos. Si no se controlan, las células malignas eventualmente pueden diseminarse más allá del tumor original a otras partes del cuerpo. El término “cáncer de mama” se refiere a un tumor maligno que se ha desarrollado a partir de células en la mama. Por lo general, el cáncer de mama comienza en las células de los lóbulos, que son las glándulas productoras de leche, o en los conductos, los conductos que drenan la leche desde los lóbulos hasta el pezón. Con menos frecuencia, el cáncer de mama puede comenzar en los tejidos del estroma, que incluyen los tejidos conectivos grasos y fibrosos de la mama. Anatomía mamaria. Una mama se compone de tres partes principales: lóbulos, conductos y tejido conectivo. Los lóbulos son las glándulas que producen la leche. Los conductos son tubos que llevan la leche al pezón. El tejido conectivo (que consta de tejido fibroso y graso) rodea y mantiene todo unido. La mayoría de los cánceres de mama comienzan en los conductos o lobulillos. Con el tiempo, las células cancerosas pueden invadir el tejido mamario sano cercano y llegar a los ganglios linfáticos de la axila, pequeños órganos que filtran sustancias extrañas en el cuerpo. Si las células cancerosas ingresan a los ganglios linfáticos, tienen un camino hacia otras partes del cuerpo. El estadio del cáncer de mama se refiere a cuánto se han propagado las células cancerosas más allá del tumor original (consulte las Etapas del cáncer de mama a continuación para obtener más información). El cáncer de mama siempre es causado por una anomalía genética (un “error” en el material genético). Sin embargo, solo entre el 5 y el 10 % de los cánceres se deben a una anomalía heredada de la madre o el padre. En cambio, el 85-90% de los cánceres de mama se deben a anomalías genéticas que ocurren como resultado del proceso de envejecimiento y el “desgaste” de la vida en general. Hay pasos que cada persona puede tomar para ayudar a que el cuerpo se mantenga lo más saludable posible, como comer una dieta balanceada, mantener un peso saludable, no fumar, limitar el consumo de alcohol y hacer ejercicio con regularidad (aprende lo que puedes hacer para controlar los factores de riesgo de cáncer de mama ). Si bien estos pueden tener algún impacto en su riesgo de contraer cáncer de mama, no pueden eliminar el riesgo. Desarrollar cáncer de mama no es culpa tuya ni de nadie. Sentirse culpable o decirse a sí misma que el cáncer de mama ocurrió por algo que usted o cualquier otra persona hizo, no es productivo. Etapas del cáncer de mama Mama en etapa temprana El cáncer de mama en etapa temprana se refiere a las etapas 0-III Cáncer de mama en etapa tardía o avanzada El cáncer de mama en etapa tardía se refiere a la etapa IV o cáncer de mama metastásico (MBC) Etapas del cáncer de mama La estadificación es un término estándar que se usa en la profesión médica para comunicar qué tan extendido o avanzado está el cáncer en el tejido mamario y posiblemente en otras partes del cuerpo. Si le diagnostican cáncer de mama, los médicos y patólogos examinarán los resultados de la biopsia y las imágenes para determinar la etapa, también conocida como progresión, de la enfermedad. El proceso es complicado pero necesario para determinar el mejor plan de tratamiento para su tipo particular de cáncer. El sistema de estadificación más común es el TNM (Tumor, Nódulo, Metástasis; más sobre esto a continuación), que se centra en el tamaño del tumor, la afectación de los ganglios linfáticos y la diseminación metastásica del cáncer. También tiene en cuenta detalles relacionados con los receptores hormonales, la proteína HER2 y la tasa de crecimiento de las células. Los médicos utilizan la estadificación de su tumor para explicar la amplitud y el alcance del cáncer y les ayuda a determinar cómo avanzar con el tratamiento, incluida la cirugía, si es necesario. Los médicos usan pruebas de diagnóstico para determinar la etapa del cáncer, por lo que es posible que la estadificación no esté completa hasta que se terminen todas las pruebas. La etapa de un cáncer de mama está determinada por las características del cáncer, como su tamaño y si tiene o no receptores hormonales. La etapa del cáncer le ayuda a usted y a su médico a: • averiguar su pronóstico, el resultado probable de la enfermedad • decidir las mejores opciones de tratamiento para usted • determinar si ciertos ensayos clínicos pueden ser una buena opción para usted El estadio del cáncer de mama generalmente se expresa como un número en una escala de 0 a IV; el estadio 0 describe los cánceres no invasivos que permanecen dentro de su ubicación original y el estadio IV describe los cánceres invasivos que se han propagado fuera del seno a otras partes del cuerpo. Estadificación clínica vs. patológica La estadificación clínica se basa en los resultados de las pruebas realizadas antes de la cirugía. Si su biopsia resulta positiva, su médico puede ordenar pruebas adicionales para obtener una mejor comprensión de si las células cancerosas se han diseminado y hacia dónde. Este período de recopilación de datos puede incluir exámenes físicos, mamografías, ecografías y resonancias magnéticas. En algunos casos, su médico también puede ordenar una tomografía computarizada o de huesos. La estadificación patológica se basa en lo que se encuentra durante la cirugía para extirpar tejido mamario y ganglios linfáticos. Si bien muchas de las pruebas antes mencionadas pueden brindarle a su equipo oncológico mucha información y puntos de datos, no es hasta que se realiza la cirugía en la que los cirujanos pueden extirpar el tumor y los posibles ganglios linfáticos para confirmar el tamaño del tumor, el número de afectación de los ganglios linfáticos y si el cáncer ha hecho metástasis o no. Cáncer de mama en etapa temprana El cáncer de mama en etapa temprana se refiere a las etapas 0-III. Etapa 0 Los cánceres en etapa 0 se denominan “carcinoma in situ”. Carcinoma significa cáncer e “in situ” significa “en el lugar original”. Los tipos de “carcinoma in situ” incluyen • CDIS: carcinoma ductal in situ • CLIS: carcinoma lobulillar in situ • Enfermedad de Paget del pezón Etapa I El estadio I se puede dividir en estadio IA y estadio IB. La diferencia está determinada por el tamaño del tumor y los ganglios linfáticos con evidencia de cáncer. Etapa II El estadio II significa que el cáncer de mama está creciendo, pero aún está contenido en la mama o el crecimiento solo se ha extendido a los ganglios linfáticos cercanos. Esta etapa se divide en grupos: Etapa IIA y Etapa IIB. La diferencia está determinada por el tamaño del tumor y si el cáncer de mama se ha propagado a los ganglios linfáticos. Etapa III El cáncer en etapa III significa que el cáncer de mama se ha extendido más allá de la región inmediata del tumor y puede haber invadido los ganglios linfáticos y los músculos cercanos, pero no se ha propagado a órganos distantes. Esta etapa se divide en tres grupos: Etapa IIIA, Etapa IIIB y Etapa IIIC. La diferencia está determinada por el tamaño del tumor y si el cáncer se ha propagado a los ganglios linfáticos y al tejido circundante. Etapa IV En la Etapa IV, el cáncer se ha diseminado a otros órganos y partes del cuerpo más allá del seno. Esta etapa a menudo se denomina cáncer de mama metastásico (CMM) y es más difícil de tratar debido al impacto en otros órganos. Los síntomas del cáncer en etapa IV incluyen hinchazón visible en el seno y la axila; piel seca y escamosa; piel roja con hoyuelos; secreción del pezón; dolor en los senos; fatiga; insomnio; pérdida de apetito; pérdida de peso; dificultad para respirar y otros síntomas relacionados con los órganos específicos involucrados. Aunque el cáncer de mama en etapa IV no es curable, es tratable hasta cierto punto y los avances actuales en investigación y tecnología médica significan que cada vez más mujeres viven más al manejar la enfermedad como una enfermedad crónica con un enfoque en la calidad de vida como un objetivo principal. Con excelente atención y apoyo, así como motivación personal, el cáncer de mama en estadio IV puede responder a una serie de opciones de tratamiento que pueden prolongar la vida durante varios años. Sistema de estadificación TNM Los médicos usan el sistema TNM para asegurarse de que los profesionales médicos usen el mismo lenguaje y sistema para describir el tumor. T se refiere al tamaño del tumor medido en centímetros y dónde está ubicado. N se refiere al número de ganglios linfáticos que dieron positivo para el cáncer. Si no hubiera ganglios linfáticos afectados, el informe patológico indicaría N(0). M se refiere a si el cáncer ha viajado o no a una parte distante del cuerpo, como los huesos o los órganos. Si se ha propagado, indicará dónde y cuánto. Por ejemplo, el estadio IIB puede decir algo como esto: (T3, N0, M0), lo que significa que el tumor mide más de 55 mm y no se ha propagado a los ganglios linfáticos ni a otras partes del cuerpo. Directrices de puesta en escena actualizadas El Comité Conjunto Estadounidense sobre el Cáncer (AJCC) estableció la forma en que se comunica el cáncer. Los médicos y la comunidad de vigilancia cuentan con el AJCC para obtener los datos de estadificación anatómica más completos disponibles, es decir, el Manual de estadificación del cáncer y el Atlas de estadificación del cáncer. En 2018, el AJCC actualizó las pautas de estadificación del cáncer de mama para agregar otras características del cáncer al sistema T, N, M para determinar la etapa del cáncer. Además de conocer el estadio de tu cáncer, el cáncer de mama también se clasifica según otras características. Estos incluyen cuán sensible es a las hormonas estrógeno y progesterona, así como al nivel de ciertas proteínas que desempeñan un papel en el crecimiento del cáncer de mama, como HER2. También se clasifica por la composición genética del cáncer. • Grado del tumor: una medida de cuánto se parecen las células cancerosas a las células normales • Estado del receptor de estrógeno y progesterona: ¿las células cancerosas tienen receptores para las hormonas estrógeno y progesterona? • Estado de HER2: ¿las células cancerosas están produciendo demasiada proteína HER2? • Puntuación Oncotype DX, si el cáncer es receptor de estrógeno positivo, HER2 negativo y no hay cáncer en los ganglios linfáticos. Las pautas modificadas anteriormente han ayudado a crear y reforzar los avances en tratamientos ontológicos/quirúrgicos. Como puede imaginar, la estadificación es una tarea compleja y estas últimas pautas del AJCC permiten un diagnóstico y opciones de tratamiento más coherentes y universales. Escucha el podcast