Think pink.

Breast reconstruction
AFTER A MASTECTOMY
BY Dr. Stephen Vega, MD, medical director, Breast Reconstruction, Unity Hospital

Advertising supplement to Messenger Post Media for the week of October 6, 2013

MESSENGER POST MEDIA

AWARENESS
Month

BREAST CANCER

October is

At the end of this year, at least 230,000 American women will have received a diagnosis of breast cancer. While that number is overwhelming, the prognosis on survival has increased every year for the past 25 years. Many women will choose to have a mastectomy, a total removal of the breast, to treat or prevent breast cancer. Though often effective, mastectomies can have emotional repercussions for women. To combat these struggles, women may look to plastic surgeons for breast reconstruction surgery, restoring their bodies to a place of comfort and confidence. After receiving a cancer diagnosis, women are often afraid, and the idea of a mastectomy may amplify their fear. The decision to get a mastectomy is an incredibly difficult one for women, and they often find themselves lacking self-confidence, sex drive and a sense of femininity following the procedure. The potential for breast reconstruction offers many of these women a silver lining when everything seems to be falling apart. Breast reconstruction is an option many patients consider as part of their healing process.One of the most popular microsurgical options is the DIEP (deep inferior epigastric perforator) Flap.Essentially, this procedure takes the skin, fat and blood cells removed in a tummy tuck and uses them to form a natural-looking breast. The plastic surgeon then places this breast mound in the patients chest.Using a microscope or loupe magnification, the plastic surgeon can reattach the blood vessels that will feed the tissue of the new breast. Because this is a microsurgery (a procedure performed using a microscope),

DIEP Flap surgery takes longer than implant reconstructions; however recovery is faster than traditional procedures and because the new breasts are natural, they have a much longer lifespan than artificial breasts, which often need to be replaced every 10-15 years. Other reconstructive flap surgeries use fat, muscle and skin from different parts of the body, like the SGAP flap from the buttocks, TUG flap from the inner thigh and latissimus flap from the upper back, to create new, natural-looking breasts. Flap choice is often determined by where you might have extra tissue for reconstruction. Implant surgeries are still practiced regularly. Women who opt for implants will need to be aware of the many associated risks. Artificial breasts can rupture, encapsulate or leak. Many advances have been made in the implant materials to prevent rupture and leak, but when this happens surgery is indicated to remove the leaking materials. Studies have proven that silicone is inert and not responsible for long term health problems, but many patients fear the consequences of having silicone leak from an implant, or simply having foreign material in their body. Probably the biggest downside to implants is their longevity. Most patients will need an exchange of implants 10 years later or even earlier in the event of a problem. Studies also suggest that long term satisfaction with implants is not as high as it is with your own tissue reconstruction. Many women may choose to have their reconstruction as part of their mastectomy, leaving no time without a breast or breasts. As medical technology constantly updates, however, women who have had mastectomies may opt for reconstruction after months or years. It takes time to get used to the loss of a breast, and it also takes time to think of the reconstructed breast as ones own, even if its reconstructed through flap surgery. Its important to have support through this process, so talk with a mental health professional

or other women who may have had reconstruction. Following reconstruction, its important to continue seeing your doctor and perform self-exams. Reconstruction rarely, if ever, hides a return of breast cancer, but it doesnt prevent its recurrence. Though breast reconstruction is not essential to restoring physical health, there are copious mental health benefits. Beyond simple cosmetic surgery, breast reconstruction can allow women who have been sidelined by cancer feel like theyre getting their lives back to normal. From an emotional and physiological standpoint, reconstruction can be one of the most beneficial recovery methods for breast cancer. Dr. Stephen Vega completed his undergraduate studies at Amherst College and went to medical school at the University of Pennsylvania. He did his residency in plastic surgery at the University of Rochester Medical Center, as well as a fellowship in microsurgery and breast reconstruction. After training, Dr. Vega remained on the academic faculty at the University of Rochester where he was dedicated to advancing the field of breast cancer reconstruction. Dr. Vega has had specialized interest in microsurgery and more specifically in DIEP/SIEA/TUG/SGAP flap reconstruction. Dr. Vega has a private practice, Vega Plastic Surgery and Medspa in Pittsford, and directs a fellowship in reconstructive microsurgery for plastic surgery graduates sponsored by the American Society of Reconstructive Microsurgery. He is also the medical director of Breast Reconstruction at Unity Hospital. Unity Health System 89 Genessee Street, Rochester 585-723-7000 www.unityhealth.org

Improving your odds AGAINST BREAST CANCER

BY By Lori Medeiros, MD, CM, FRCSC, FACS | MEDICAL DIRECTOR, rochester general BREAST CENTER

As a breast cancer surgeon, there are two common questions I am often asked by patients and friends: What causes breast cancer? and How do I prevent it? Today, about 1 of 8 women in the United States is expected to be diagnosed with breast cancer in her lifetime. But we can significantly impact the outcomes. Minimize Controllable Risk Factors While the exact causes of breast cancer are unknown, factors shown to increase risk include: Alcohol Consumption - Women who regularly drink more than 3-6 drinks weekly, more than two glasses of alcohol a day, or are chronic binge drinkers have higher rates of breast cancer than those who drink in moderation or not at all. Excessive Weight - Obesity, particularly after menopause, seems to increase the risk of breast cancerpossibly due to increased estrogen produced in fat cells. Maintaining healthy weight through diet and exercise may aid in preventing a host of health problems, including breast cancer.

Hormone Therapy - Combination hormone replacement therapy is thought to contribute to breast cancer risk. Consider using these therapies for the shortest possible time in the lowest doses, or using alternative treatments options. Good news about breast feeding and oral contraceptives: Studies have shown that breastfeeding can lower the risk of breast cancer. Current evidence also suggests that oral contraceptive use does not significantly increase risk, and if used for five consecutive years in your 20s and 30s may actually decrease your risk of ovarian cancer. Be Aware of Risk Factors You Cant Change Just being aware of certain factors can make a difference in prevention and risk reduction. Talk to your physician about any of the following: A Personal History of breast cancer or high risk lesions Age & Gender - Breast cancer occurs in women of all ages, and even men, but is much more common in women over age 50. Family History - A family history of breast cancer, ovarian cancer, certain cancer syndromes and gene mutations place you at higher risk for breast cancer.

Reproductive History - Menstruating before age 12, menopause after age 55, or having children late or not at all, are factors that increase risk. Radiation Treatments - Unavoidable high doses of radiation to the chest, such as during treatment for Hodgkins disease increases breast cancer risk especially if treatment occurred during breast development. DES - Women who took diethylstilbestrol (DES) in the 1940s to 1960s to prevent miscarriage, or who were exposed in utero, may have an increased risk of breast cancer. Early Detection The most powerful way to improve your odds against breast cancer is early detection. Breast cancer survival is strongly related to stage at diagnosis. Current data suggests the 5-year survival rate from Stage 0 breast cancer is over 90 percent, while five-year survival at Stage 4 is 15 percent. While early detection isnt the only factor, it is a major one. Two important components of breast cancer detection are: Imaging - Mammograms are still our best tool to detect breast cancer early. Continued on Page 2...

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the Survivorship Journey

BY Michelle Shayne, MD

Life after breast cancer

What is new in breast cancer

detection and diagnosis?
By Stamatia Destounis MD, FACR

Youve just finished your last round of chemotherapy or radiation. Emotionally, youve been tested like never before. You survived! Where do you go from here? The survivorship phase of breast cancer can present challenges as you ease back into your daily life, and find your new normal. You are joining a group of almost three million breast cancer survivors in the U.S. and growing thanks to breakthroughs in research, earlier detection, more accurate diagnoses and targeted treatments. And while many of these survivors lead long and fulfilling lives, cancer and cancer treatment can be followed by delayed or long-term physical and emotional challenges, including ongoing fatigue and memory deficits, higher risk of cancer recurrence, heart disease, depression and sexual dysfunction. Nothing can prepare you for a cancer diagnosis, but you can plan for how to best manage the challenges and opportunities ahead as you move in to the next phase of your journey. With coordination from your primary care physician and oncologists, the following are tips for how set your path through breast cancer survivorship: Pace yourself. You cant rush healing from cancer treatment. Your new normal might include the amount of activities you can take on in one week, or easing back into a work schedule. Get the facts. Having information at your fingertips can be settling and make you feel more in control of whats next. Ask your oncology team for the details about your diagnosis and treatmentthe exact stage and type of cancer, any surgery or procedures, what type of chemotherapy and the dose, as well as radiation dosages and locations of the body it was delivered. Find strength in your community. Hearing the perspective of someone who has walked in your shoes can help you cope with some of the emotional and physical side effects of post-cancer treatment. Seek out breast cancer support groups in your community, as well as online, to connect with others effected by the disease. Become a foodie. A healthy lifestyle is built on a nutritious diet. Find a nutritionist that understands the unique needs of a breast cancer survivor. Find fun ways to incorporate these foods into your daily routine, take a cooking class, or start a healthy supper club with friends. Move your body. While this may not be feasible at the beginning of your recover, light physical activity will assist in leading a healthy life moving forward. Yoga, hiking or dancing are just a few fun and engaging ways to get moving. Understand what could come next. While youve just

had to process all of the information on your diagnosis and treatment, it is important to also understand the possible late effects of the specific treatment you received. Dont be a hero. Cancer treatment can cause you to have lingering pain, fatigue and chemobrain that impairs your memory or ability to focus. Dont hesitate to call your oncologist to discuss ways of how to manage any symptoms or address any questions you might have. It is common to be anxious about your health and everyone is unique in the way that they cope. Remember, every cancer survivor is differentsome require more information and support services than others depending on diagnosis and treatment. Defining what wellness is for you and setting a path to being healthy again will only help you better enjoy the next steps of your journey. The James P. Wilmot Cancer Center at the University of Rochester Medical Center is helping patients navigate the complexities of breast cancer survivorship care with the Judy DiMarzo Survivorship Programthe first in the region to offer this comprehensive approach to survivorship. The ultimate goal of the program is to become a regional resource for all cancer survivors and work with primary care physicians and community programs across the region to best serve this growing population. For more information about the program, please call 585-275-6956. Michelle Shayne, M.D. is a breast oncologist and the clinical co-director of the Judy DiMarzo Survivorship Program at the James P. Wilmot Cancer Center at the University of Rochester Medical Center. Dr. Shaynes clinical and research interests are in breast cancer and survivorship.

A mammogram is a well known screening exam for breast cancer detection and has been proven effective over several decades. In more recent years digital mammography has been implemented and has allowed acquisition of images of each breast that are viewed by the radiologist interpreting the mammogram on a computer workstation. Each womans breast is unique in that it is made up of varying amounts of glandular, fatty or fibrous breast tissue. The more fibrous and glandular tissue present, the more dense the breast tissue is and the more challenging the interpretation of the mammogram may be for the radiologist reading the study. What does this mean to a woman presenting for her screening study? If she has dense breast tissue (which is determined only by a mammogram) she must understand that dense tissue reduces the ability for some breast cancers to be detected. A small cancer may hide in the dense breast architecture and it is difficult to identify on a routine mammogram. As of January 2013 a mandate was passed by New York State requiring patients be informed of their breast density along with the results of the mammogram. If the breast was composed of dense breast tissue, a recommendation must be included for the patient to speak with her primary care physician (family doctor, or gynecologist) regarding additional screening tests that may be helpful for early breast cancer detection. Additional tests may include breast ultrasound and or breast MRI. The mandates goal is to inform women of their breast density and allow discussion with women and their doctors regarding their breast cancer risk and review factors that may add to their risk of breast cancer. Risk factors may include: family history of breast cancer, other related cancers and prior breast surgical biopsy revealing atypical (precancerous) cells are a few of the factors. A mammogram that reveals dense breast tissue may limit the ability of the radiologist to interpret the exam and also may make breast self exam by the patient and clinical breast exam by the patients doctor more challenging. By giving this information regarding breast density to each patient the belief is that women will understand some of the limitations of mammography and seek out their physician if a lump is found on their breast self exam, or if they have any change from previous self exams, even in the face of a recent normal mammogram. The education and information is meant to empower women and allow them greater participation in their breast care through open discussion with their physicians regarding potential risk factors and recommendations for additional testing. A new technology made available in the last two years is 3D digital breast tomosynthesis. This is a combination study including the standard mammogram and a 3D mammogram of each breast. This technology uses equipment very similar to a mammography unit which takes several images of each breast in the standard Continued from Page 1... The American Cancer Society and other specialty groups concerned with early detection recommend mammograms starting at age 40. Women at high risk, including those with very dense breasts, may benefit from additional, complementary tests such as MRI and ultrasound. Physical Exam - Physical exams are critical to support early detection. At each exam, your doctor should physically check for suspicious lumps, skin or nipple changes, or unusual nipple discharge that occurs without manipulation. Regular self-exams are also important. Women who practice breast self-awareness are more

projections. This allows visualization of dense breast tissue with less difficulty and may help the radiologist be more accurate in seeing through the breast tissue more readily. Breast ultrasound may be added as an additional screening test if the mammogram reveals dense breast tissue. Ultrasound is a safe, relatively inexpensive and easily accessible exam offered by most imaging facilities. Ultrasound may help identify non-cancerous masses such as cysts, fibroid nodules, and scar tissue. Findings discovered initially may be deemed suspicious enough to warrant a needle biopsy to diagnose the nature of the lesion. Thus ultrasound may identify lesions that turn out to be false alarms and lead to unnecessary additional procedures. Breast MRI may be another test ordered in some circumstances as an additional screening test for specific cases where the patient has a considerable lifetime risk for breast cancer. If a woman has enough risk factors to qualify for an MRI exam this may be added to her screening regimen for her breast health. Studies have shown that women in high risk categories (such as strong family history of breast cancer, personal history of breast cancer at a young age) will benefit from MRI as cancers that may have gone undetected can be found. This exam does not utilize radiation but it is a lengthy exam and requires specialized equipment along with an injection of contrast material. This is not an examination for women of low or average risk for breast cancer. This is an exciting time for breast cancer detection as many new and also well tested technologies are available. Informing women about their breast density may lead to additional testing such ultrasound, MRI, and possibly needle biopsy. These additional exams may identify some breast cancers sooner. The benefit of earlier breast cancer detection may outweigh the risk andhealthcare cost of additional testing. Data will need to be collected over time from the patients examined to tell us how large the benefits may be. The hope isthat as new technologies are available and patient information and education increases, women will ask questions from their healthcare providers and make informed decisions regarding their breast health. Dr. Destounis is a radiologist at the Elizabeth Wende Breast Care, LLC. in Rochester, where she has been practicing since 1993 after completing her breast imaging fellowship at the Elizabeth Wende Breast Clinic. In 2005, she became a Clinical Associate Professor of Radiology at the University of Rochester School of Medicine and Dentistry. In 2010, Dr. Destounis became an American College of Radiology Fellow and Society of Breast Imaging Fellow. She participates with several radiology committees locally and is a past board member of the Eastern Division of the American Cancer Society. She is actively involved with research on topics such as Computer Aided Detection, Breast Ultrasound, Digital Mammography, Breast MRI, and Digital Breast Tomosynthesis. Dr. Destounis is an invited speaker locally and nationally for radiology seminars on breast disease topics and her clinical research. She has published several peer review articles in radiology journals.

likely to notice and report changes earlier than those who do notresulting in faster detection and treatment. Treatment If you or a loved one is diagnosed with breast cancer, dont panic. With todays state-of-the-art treatments, theres an excellent chance of surviving the disease. Once diagnosed, be sure to quickly seek out treatment with a team of compassionate, knowledgeable caregivers that you trust. Breast cancer is common and scary, but awareness of risk factors, proactive steps towards a healthy lifestyle and screening, combined with medical skill and expertise help us improve the odds every day.

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to Make Every Moment Count

By Anne Johnston, Corporate Writer/Marketing Coordinator, Thompson Health

Womens Center

Jessica Salamone, certified genetic counselor at Elizabeth Wende Breast Care, LLC

Q and A

In 2014, Thompson Health plans to build a womens center across the street from the hospital in Canandaigua, with same-day testing and results, private access to all breast imaging services, and a navigation team to ensure immediate access to emotional, financial and spiritual support, as well as coordination of appointments.

Each year, more than 10,000 women receive breastimaging services from Thompson Health, which is launching a $2.5 million capital campaign for a new Womens Health and Wellness Center in Canandaigua. Located just across Parrish Street from Thompson Hospital, the new facility is expected to break ground in 2014 and will provide: Same-day testing and results, available at the same location Private access to all breast imaging services A Navigation Team to ensure immediate access to emotional, financial and spiritual support as well as coordinate all necessary appointments Thompson Foundation Director Anita Pietropaolo says Thompson is meeting the current diagnostic needs of the community with top-notch doctors, nurses and diagnostic imaging specialists as well as the most advanced technology available. However, scheduling

demands on facilities and equipment make it impossible to provide an immediate transition from one diagnostic treatment to the next. The ability to receive same-day results takes away that degree of uncertainty, she says, adding, Even when there is a diagnosis of cancer, having the results immediately allows a woman and her care team to begin making treatment plans right away. In addition to conducting screening and diagnostic mammography, breast ultrasounds, biopsies, breast tomosynthesis, drainage and localization procedures, the Womens Health & Wellness Center will offer bone density testing. The capital campaign will not only fund the construction of the facility, but endow the position of a nurse acting as a breast health navigator. To learn more, go to www.ThompsonHealth.com. Donations may be made online by calling the F.F. Thompson Foundation at 585-396-6155.

to Learn About Breast Density

BY Wendey Mulholland | director of Diagnostic Imaging for Thompson Hospital

Thompson urges women

When it comes to breast health, youve no doubt heard about the importance of yearly mammograms and monthly self-exams, but one thing you may not have heard much about is breast density. Its something getting more attention in recent months due to a new law in New York State requiring healthcare professionals to inform patients if dense breast tissue is found during an exam. So what is breast density and why does it matter? Basically, breast density is based on the amount of fibrous or glandular tissue in the breast versus the amount of fatty tissue. When a radiologist reads a mammogram, he or she compares the amount of fatty tissue to the amount of fibrous or glandular tissue and then categorizes the breast density on a scale, with 1 being almost entirely fatty tissue and 4 being extremely dense. According to the law that took effect Jan. 1, patients who are in category 3 or category 4 are to be informed of their breast density when they receive the routine letter that follows a mammogram. This information is also shared with the patients physician in the routine follow-up report. There are two reasons why its important to know your breast density: Dense tissue in breasts can make it harder to discern areas of concern within the breast, making it harder to detect small breast cancers. While common, dense breastsdetermined by genetic makeupare among the risk factors for breast cancer, along with a number of other factors including family history, weight, diet, exercise and smoking. More than 10,000 mammograms and breast ultrasounds are performed each year. She says the new state law pertaining to breast density helps ensure that women have more information when it comes to empowering themselves for better health. Its about awareness more than anything else, Mulholland says. A patient whose breasts are found to be dense is urged

to speak to her physician, who can then weigh all of the patients risk factors and determine whether further screening may be warranted. This can include breast MRI and/or ultrasound, both of which are available at Thompson. Whether a woman has dense breasts or not, the most important thing is to keep up with regular mammograms, which are recommended by the American Cancer Society for women over 40. We certainly dont want women to feel that they dont have to go for mammograms as often if they have low breast density, she says, noting that the American College of Radiology, the Society of Breast Imaging and the American Cancer Society are among several organizations promoting mammography as an effective and valuable tool in detecting breast cancer. For more information about breast density and mammography guidelines visit the website of the American College of Radiology at www.mammographysaveslives. org. For information about diagnostic imaging services offered by Thompson Health at Thompson Hospital in Canandaigua and at Thompson Urgent Care in Farmington, visit www.ThompsonHealth.com.

Over the past several years, advances in the field of cancer genetics have given patients and their providers the opportunity to determine predisposition to certain cancers, including breast cancer, in order to initiate proper medical management. Although multiple risk factors for breast cancer are known, personal and family history of cancer are key elements impacting cancer risk. Jessica M. Salamone, ScM, CGC, certified genetic counselor, provides comprehensive cancer risk assessment and genetic counseling services for patients at Elizabeth Wende Breast Care, LLC. The goal of the Cancer Risk Assessment and Genetic Counseling Program is the early detection and/or prevention of breast and other cancers. She also sees family members, and men, who may also have an increased risk of breast cancer with a family history. Up to 10 percent of breast cancers and 15 percent of ovarian cancers are considered hereditary. Of these, the majority are due to mutations in one of two major breast cancer susceptibility genes, BRCA1 or BRCA2. Women with mutations in BRCA1 or BRCA2 have up to a 50 percent risk of breast cancer by the age of 50 and up to an 87 percent lifetime risk of breast cancer. In addition to the risk of breast cancer, BRCA mutations confer up to a 44 percent lifetime risk of ovarian cancer. Ms. Salamone saw nearly 800 patients last year alone. She says each patient is unique, arriving with his or her own personal history, thoughts, beliefs, personality, and knowledge. Although the topic is the same, she never says the same thing twice. Each patient received personalized care. Below she answers some of the most common questions she hears. Who should pursue BRCA1 or 2 genetic testing? Breast cancer is incredibly common.Approximately 1 in 8 women (12 percent) of women are diagnosed in their lifetime. Genetic testing is certainly not indicated in every instance. Genetic testing for BRCA1 and 2 should be considered in individuals who have a personal or family history of: Breast cancer diagnosed before the age of 45 Pre-menopausal breast cancer Triple Negative breast cancer Ovarian cancer diagnosed at any age Male breast cancer Two primary breast cancers in the same individual Both breast and ovarian cancer in the same individual Two or more breast cancers in the family, when both are under age 50 Ashkenazi Jewish heritage A family member with a previously identified BRCA mutation Why do women pursue genetic testing? Women typically fall into one of two categories: personal history and family history Personal history - Individuals who have already been diagnosed with breast or ovarian cancer and are seeking information as to why theyre facing a diagnosis. Affected individuals might consider pursuing genetic testing to help in surgical decision making (ie should they pursue lumpectomy or bilateral mastectomy), to help determine recurrence risks either for their initial cancer or another type of cancer or to help their family members understand their risks and begin an appropriate screening plan. If positive, women in this category might choose a more aggressive approach to their treatment plan due to a high recurrence likelihood. A woman with a positive genetic test drawn after a breast cancer diagnosis might also consider a hysterectomy due to an increased likelihood of ovarian cancer. Family history - Individuals who are concerned about their family history and wonder how it impacts their personal risk. They are typically pursuing genetic testing to help determine if their current screening practices are sufficient, to help determine their lifetime risk of cancer/(s) and to help other family members understand both their risk and to begin appropriate screening. This

is the category of women, like Angelina Jolie, who may make a risk-reducing surgery decision prior to a personal diagnosis. Both prophylactic mastectomy and hysterectomy reduce a womans likelihood of cancer by 90-95 percent. Those with a positive genetic test are given the option of screening or surgery as a means to reduce their cancer risks. How much does testing cost? BRCA1 and 2 testing is expensive, nearly $4,000. However, when appropriate personal and family history conditions are met, insurance will typically cover the cost of analysis. This is one reason that having a genetic counselor guiding a patient through the testing process is important.In some instances, testing can be far less expensive depending on ethnicity and if a mutation has previously been identified within the family.In the latter case, testing is only $400 but requires the patient to obtain their relatives positive test result. What happens at a genetic counseling visit? There are usually two appointments, an intake and a results appointment. The genetic counseling and testing process includes meeting with a genetic counselor who will obtain your family history and determine the appropriateness of BRCA1 and 2 testing.The counseling session also includes an overview of genetics, discussion of the testing process and logistics, review of associated cancer risks, medical management options, impact of the results on family members as well as psychosocial counseling. Emotions often include anxiety, stress, guilt and uncertainty about wanting to know your personal risk of cancer. If interested, a patient can submit a blood or saliva sample for analysis. Results are typically available two to four weeks later. During the results session and depending on what the results revealed, the genetic counselor will discuss the best clinical management plan. If an individual tests positive, they could have a lifetime breast cancer risk of 84-87 percent (compared to a typical womans risk of 12 percent,) and a lifetime ovarian cancer risk of 2744 percent (compared to a typical womans risk of 2 percent). In that instance, a woman would be given the option of surveillance (yearly mammograms and MRIs and/or transvaginal ultrasounds and bloodwork) or surgery (mastectomy and/or hysterectomy). NOTE: BRCA1 and BRCA2 mutations also confer a risk for prostate cancer, male breast cancer, melanoma, pancreatic and kidney cancers. Are there other breast cancer genes? Yes. BRCA1 and BRCA2 are just two of many breast cancer genes. Genetic testing is available for other breast cancer genes as well as other types of early onset cancers syndromes. It is important to consult with a genetic counselor or medical geneticist if youve had previous negative genetic testing for BRCA1 and 2 and wonder if your cancer could be related to a different gene mutation. Should I be concerned about insurance discrimination? In May of 2008,the Genetic Information Non discrimination Act or GINA, was signed into law. This law prevents Americans from being treated unfairly because of differences in their DNA.It prevents discrimination from health insurers and employers. GINA prohibits the use of genetic information in setting eligibility, premiums or contribution amounts by group and individual health insurers. It also prevents insurers from requesting or requiring an individual or family member to undergo a genetic test. Ms. Jessica Salamone has been a Board Certified Genetic Counselor since 2005. Before joining EWBC, Ms. Salamone worked at the University of Rochester Medical Center for 10 years, where she provided genetic counseling to patients in a variety of clinical settings including reproductive, pediatric and cancer genetics. Ms. Salamone is also adjunct faculty at Rochester Institute of Technology, where she teaches medical genetics and introductory genetic counseling courses. For more information please contact: Jessica Salamone, ScM, CGC. 585-758-7057. Elizabeth Wende Breast Care, LLC 170 Sawgrass Drive/ Rochester, NY 14620 585-442-2190 www.ewbc.com

Embrace Your Sisters (EYS) began in 2005 when a group of friends wanted to financially and emotionally help another friend with breast cancer. They continued fundraising and realized the incredible need of others in the area. Many people diagnosed with breast cancer are unable to work during their illness or treatment, which adds a huge financial toll to an already difficult struggle. This entirely volunteer organization fills a unique niche in breast cancer services by providing short-term

emergency financial assistance. A grant from EYS can help with mounting co-pays and medical expenses. It can also help patients with rent/mortgages, utilities, and other necessary expenses in order to maintain quality of life and a stable environment. EYS also provides breast cancer education regarding the need for self and doctor examinations, mammograms and the availability of free mammograms. The recently completed Kims Breast Cancer Support Handbook is available at www.embraceyoursisters.org. For more information please contact Sue Cooney, Embrace Your Sisters President at 585-919-9999.