Category Archives: Breast Cancer Awareness

Work Together to Reduce Errors in Cancer Diagnosis

By Hui Xie-Zukauskas

Patient engage comm._CPDHave you or your family member ever gotten a wrong diagnosis from your doctor? Have you heard that a doctor treated your friend for a disease or disorder that he/she actually didn’t have? “It is likely that most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences,” according to the experts on diagnostic safety.

Imagine you were diagnosed with breast cancer and went through cancer treatment, then found out the diagnosis was wrong and the treatment should never have happened. That could spell enormous damage from one diagnostic error!

Cancer diagnostic errors can be the most harmful and costly type of diagnostic errors in various ways. As many cancers are complex and multifaceted, a timely and accurate diagnosis for cancer is still often challenging. That adds weight to preventing cancer altogether and urgency to detecting cancer early.

That’s why I bring your attention to this issue: A diagnosis is something that’s done for a patient (you) and the patient (you) needs to be a part of the team in that process.

1.      Basics and facts

What is a “diagnostic error”?

The Institute of Medicine (IOM) defines a diagnostic error as the failure to:

a. Establish an accurate and timely explanation of the patient’s health problem(s); or

b. Communicate that explanation to the patient. 

What is the reality?

40,000 – 80,000 deaths each year are due to diagnostic errors, as reports vary. However, national diagnostic safety experts, Drs. Graber and Schiff, emphasize that the frequency of diagnostic error is in the range of 10%.

Does it sound like misdiagnosis happens far more frequently than you thought?

2.      When does diagnostic error occur and who may be involved?

No doubt, human factors contribute to diagnosis errors. Studies have reported that communication problems are the most frequent root cause of serious events threatening patient safety. Today’s health-care systems are transforming toward not only integrated care practice but also enhanced patient engagement, to this end, everyone is involved.

Let me bring cancer diagnosis to the forefront. A delayed cancer diagnosis may occur at various stages of the journey to fight cancer. It could be a delay in:

  • symptom recognition or interpretation,
  • decision or action to seek medical attention (e.g., putting off making an appointment due to fear or feeling embarrassed),
  • a care system’s scheduling (e.g., not being seen by a doctor in a timely fashion),
  • clinical tests or subsequent consultations, or
  • receiving cancer treatment.

In addition, putting off doing anything might simply be due to lack of insurance coverage.

Here is the key point: Delayed cancer diagnosis at an early stage may leave the cancer to progress or spread, leading to limited treatment options. Thus, a delay in cancer diagnosis can have devastating consequences, including poor clinical outcomes and a lower chance of survival.

3.      How can you help reduce or prevent diagnostic errors?

Here are 15 things you can do to enhance your communication with your doctor, medical care team, and health care system.

1)      Prepare for your visit: know or collect your medical records, medications, and family history.

2)      Remember your screenings and, importantly, follow up. Having a separate calendar can assist your memory.

3)      Always bring a list of questions or at least your top three questions when visiting your physician.

In case you don’t know where to start, Agency for Healthcare Research & Quality provides a list of questions to ask your doctor. You can also generate your own list using their Question Builder. It’s a fantastic tool!

4)      Bring your spouse or a family member to your doctor visit to facilitate communication and/or fill in missing information that might help with diagnosis or treatment.

5)      Use technology (e.g., a smartphone) to record the conversation or instructions.

6)      Feel free to ask the doctor to clarify terminology or procedure. If you don’t understand why a particular question is relevant to your situation, ask about it or let a family member do so.

7)      If you have a limited English proficiency, make sure you have a family member or a friend act as a translator.

8)      Participate in a patient experience survey to improve patient safety and care.

9)      Get involved in facilitating the chain of communication—e.g., in scheduling appointments, visits, follow-ups, and even questioning an insurance billing if you don’t understand it.

10)  Don’t self-diagnose, especially based on online information from an unreliable source.

11)  Do keep a diary or inventory of your symptoms for better recollections when needed.

12)  Seek a second opinion or multiple consultations on cancer diagnosis when in doubt or if necessary. The second opinion must be an expert’s one. Be proactive.

For example, if you have a lump in your breast but get a normal mammogram—after all, mammograms pick up only 80-90% of breast cancer. So, for your safety, you should ask for further screening, e.g., a breast ultrasound (sonogram) or even a test with a higher sensitivity like magnetic resonance image (MRI) to ensure accuracy if your physician doesn’t order such tests.

13)  If diagnosed with cancer, follow up vigorously and treat any referrals to specialists, tests, or care with urgency.

14)  Further the discussion about potentially discrepant diagnosis or different finding.

15)  When you have unintentional weight loss or unexplained pain, take it seriously and see your doctor.

One more point – Misdiagnosis may not be discovered for years if ever in some cases. That’s why I cannot emphasize enough how prevention and early diagnosis of cancer offer clear and significant benefits, especially concerning common cancers (the breast, prostate, colon, lung, and skin cancer).

Although I talked more about cancer, these principles can be applied to any other illnesses. And I’ll elaborate with more details in near the future. Stay tuned.

Finally, your take-home message: Actively engage in your health care!

Improving diagnosis for patient safety and for better health care is a responsibility of each of us. Doing that can alone save many lives.


A Genetics and Energy View of Breast Cancer Prevention

By Hui Xie-Zukauskas

BRAC genes illustration_Rev_CPD 2015For breast cancer awareness, it’s important to do something beyond wearing “PINK in October.” So today, I’d like to focus on two factors related to breast cancer: genetics and energy.

First, let me use a simple diagram (as seen here) to illustrate how a mutation of BRCA genes is linked to breast cancer.

BRCA1 and BRCA2 genes are cancer suppressors. Their function is to protect a cell from developing cancer, thereby helping you fight cancer. When either of these genes becomes mutated, it no longer functions properly. As a result of unrepaired DNA damage and impaired genetic integrity, cells are more likely to grow uncontrolled to develop cancer, like a car racing on the highway without brakes.

Each of us has BRCA1 and BRCA2 genes, both women and men, because BRCA is not a sex-linked gene. The mutation can be inherited from either parent. For women with a BRCA mutation, the lifetime risk of breast cancer is approximately 80%, and the chance of ovarian cancers is 54%. Men may carry the BRCA mutation, but have a lower risk.

Among approximately 200,000 breast cancer cases each year, BRCA gene mutation accounts about 10 percent of them. So, clearly here there is a promising area for treatment and prevention.

Next, let’s approach the topic from the viewpoint of energy.

“Energy” in Traditional Chinese Medicine (TCM) is termed “Qi.” Everything is energy at both the physical and spiritual levels. Essentially, the root of cancer is Qi related. There is a principle in TCM – “Flow of Qi makes flow of blood; Qi stagnation causes blood stagnation,” which implicates clots, masses, tumors, and illness.

How can we use positive and healing energy to prevent or cure cancer? Here are 8 ways:

  1. Makes our immune system strong. Our immune system is our powerhouse to fight cancer. That’s why scientific innovations tap into the body’s immune system to destroy cancer cells. When cancer overwhelms your body’s immune capacity and healing power, it is a tragic ending.
  2. Take care of your emotions. Keeping a positive outlook on life will boost your positive energy, because stress is one of risk factors for breast cancer. Anger, fear, sadness, and worry affect your Qi negatively, but happiness and socializing build up vibrant Qi.
  3. Foster gratitude. Devote time (at least a few minutes a day) to appreciate what you have, even the “small things”. Doing so will boost your positive energy!
  4. Go for a nutrient-packed diet. Consume fruits and vegetables and other foods with high fiber, low fat, and low sugar, because nutrition boosts both level and quality of your energy. Alcohol, animal fats, and processed foods do not.
  5. Exercise regularly. Be physically active, because it keeps Qi moving and blood flowing!
  6. Maintain a healthy weight. The key to weight management is energy balance. Obisity is energy imbalance and contributes to the risk of breast cancer. Healthy weight plays a role in lowering the risk of cancer and that of cancer recurrence.
  7. Be vigilant about early detection! Get a genetic screening to identify BRCA gene mutation, and start treatment early. Doing so will help protect your vital energy.
  8. Prevention, prevention, and prevention. Preventive care keeps your energy moving in the right direction. We all know that prevention is better than cure.

To sum up—

Breast cancer prevention is for both women and men, and is a year-round practice. We cannot control our genes, gender, age, race, or family history. However, each of us can promote a healthy lifestyle to boost vibrant, positive energy to reduce breast cancer risk.

Daily Risks for Breast Cancer: Everybody Can Do Something

By Hui Xie-Zukauskas

Pink_breast cancer awareWhat do you do in Breast Cancer Awareness Month? What do you do in a year for breast cancer prevention?

Unless you have a well-defined plan, here is food for thought.

In addition to wearing pink or a pink ribbon, campaigning to raise funds and getting a mammogram, there are essential things that everybody can do in this month and year round.

Why everybody? Because both men and women can get breast cancer, and because you care about your loved ones.

First of all, the key to fighting breast cancer is to catch it early. The cancer is most treatable at an early stage.

Then the best cure is prevention. Surely, you cannot control certain risk factors such as family history and/or genetics. However, do you know – about 85% of women diagnosed with breast cancer have no family history of breast cancer? This means that DNA mutation can occur over one’s lifetime, and that’s why lowering your risk for breast cancer is critical.

So what are five most common daily risks for breast cancer?

  1. Smoke
  2. Alcohol
  3. Junk foods (processed foods, food low in nutrients but high in fat, sugar and salt)
  4. Physical inactivity
  5. Environmental pollutants and toxins

Everybody can relate to these health hazards, right? Be aware, some of them are hidden. Of course, there are other risk factors for breast cancer, including hormone therapy, radiation exposure, aging, and sleeping pattern (night shift).

I want to stress that it’s not one single factor that plays a measurable role in causing any cancer. Multiple or combined factors contribute to the development of breast cancer. For instance, when combined with genetic factors, alcohol consumption and cigarette smoking enhance a risk for breast cancer and several other cancers as well. Furthermore, each cancer is different; no two people have the exactly same cancer.

Next, how to reduce breast cancer risk?

Breast cancer prevention starts with a healthy lifestyle, such as stopping tobacco use, limiting alcohol consumption, getting a nutritious diet, staying physically active, keeping a healthy weight, and avoiding environmental toxins if you can.

Lifestyle modification is often most effective and goes a long way. But it doesn’t happen overnight. Live a healthy lifestyle by starting with small, simple steps on a daily basis. Just consider food. Eating a diet rich in fruits and vegetables, especially a low-fat diet have been shown to offer protection from breast cancer. Plus, eating healthy can help you maintain a healthy weight and decrease your risk for several other types of cancer.

Regular physical activities also offer you some protection. Research has demonstrated that women who exercised vigorously or moderately were significantly less risky to get breast cancer compared with non-exercisers.

In summary, focus on what you can do to lower your cancer risk. If you’re at an increased risk, breast cancer can be closely monitored with advanced technology and with help of your physician(s).


Think Beyond Pink for Breast Cancer Prevention: Think Bright Colors

By Hui Xie-Zukauskas

Diet plays a critical role in a woman’s risk for breast cancer. Daily foods with bright colors are not only appetite-appealing, they can also be quite therapeutic, as research reveals that colorful fruits and vegetables are powerful weapons to fight breast cancer.

Two categories of dietary nutrients with bright colors are fruits and veggies that are red or orange/yellow.

Red grapes_comboThink Red.

Red grapes, red grape-derived products such as grape juice, and red wine are rich in resveratrol, a health-beneficial antioxidant that protect against breast cancer in both animal and human studies. Also, resveratrol offers cardiovascular protection. It’s important to remember that red and dark red grapes contain higher levels of resveratrol than green grapes and red wine.

I love sweet red grapes. I often eat red grapes as a snack or desert and incorporate them in my salads. To enjoy this nutritious red fruit, follow your taste and deploy your creativity.

Think Orange and Yellow.

Carrots bunch_1389068-mFruits and veggies with vibrant orange, yellow, and red colors are rich resources of carotenoids, organic pigments, micronutrients and antioxidants. These foods include carrots, sweet potatoes, winter squash, and red peppers, plus some greens like spinach and kale. Research shows that eating plenty of these fruits and vegetables can be particularly beneficial for women at risk of non-estrogen-dependent cancer and those with a genetically increased risk for cancer.

More-peppers_580768-mThere are many ways to increase your daily consumption of bright-colored, plant-based foods. You can use them in fresh salads or sandwiches for lunch and prepare steamed or stir-fried veggie dishes for dinner. Whatever way you choose, these healthy treats are quick and easy to prepare, and they are yummy. Similarly, regular ingestion of tomatoes does good to you, because tomatoes are a wonderful source of lycopene, one of carotenoid compounds.

Keep in mind that carotenoid-rich fruits and veggies are low in dietary lipids that facilitate human absorption of micronutrients. Therefore, it’s always wise to consume them with olive oil or avocado (i.e., healthy fat) to improve the carotenoids’ bioavailability.


Not only can a colorful diet of fruits and veggies reduce your breast cancer risk, it can protect you from other major human diseases and positively affect your mental and emotional levels. Just remember: rainbows on your plate help create a healthy rainbow in your life!


Image credits: by redvisualg; DeLaMartre; and awottawa

5 Estrogen Sources and Breast Cancer Risk

By Hui Xie-Zukauskas

Women exercise-in-the-1950s-493921-mHave you ever wondered if “Estrogen” was an issue that these energetic women thought or talked about back then?

Estrogen is a steroid hormone, made from cholesterol, occurring in both women and men. It plays a major role in the growth and development of sex organs and reproductive tissues. Conversely, too much estrogen can do other things; among them is an increased risk of cancer.

Because estrogen contributes to breast cancer, today let me direct your attention to eliminate over-stuffed estrogen from your daily life.

There are five major sources of “Uninvited Estrogen”: foods, physical inactivity, obesity, environmental toxins, and hormone replacement therapy (HRT).

Let’s go over them one by one.

1.      Poor diet and unhealthy foods

Without doubt, synthetic hormone-containing foods are available everywhere. For example, a lot of beef and dairy products are pumped up with synthetic growth hormones, which can interrupt your hormonal balance if you often consume them. Excess carbohydrates from refined foods and sugars are normally not needed for energy, so if you eat a lot, they will be stored as fat in your body. Read on to find out what happens next.

 2.      Lack of exercise

Living a sedentary lifestyle is closely associated with obesity and hormonal imbalance. Scientific research shows that exercise can regulate the balance of estrogen. So lack of exercise can cause estrogen accumulation in the body.

 3.      Obesity

Being overweight is a significant lifestyle factor related to cancer risk. Obesity is linked to breast cancer, endometrial cancer, and other cancers. Think about this. The fatty tissue is one of factories for estrogen production in the body. Here is the process:

Testosterone    via aromatase in fatty tissue —->  Estrogen

By this conversion, fatty tissue raises your estrogen levels. Research indicates that in post-menopausal women, obese individuals tend to have higher estrogen levels than their lean counterparts, and obesity is a risk factor for their development of estrogen-driven breast cancer.

4.      Environmental toxins

Xenoestrogens, you can call it “fake estrogens” or man-made toxins, are a group of chemicals present in the environment and our everyday products. They mimic the effects of estrogen in your body. When excessive estrogen is accumulated, as a result of the combination of these toxins sneaked into your body with those naturally produced by your body, normal hormone functions are compromised.

Xenoestrogens are often present in

  •       household cleaners.
  •       household plastics products (e.g. plastic containers and bottles)
  •       personal care products (e.g., nail polish and nail removers)
  •       pesticides, fungicides, or herbicides
  •       industrial pollutants.

 5.      Hormonal replacement therapy (HRT) and birth control pills

Estrogen and progesterone are naturally occurring hormones. Although women (under 60 years old) can benefit from HRT for menopause related symptoms, clinical studies also reveal that HRT poses higher risks for breast cancer, cardiovascular events such as heart attack and stroke. Likewise, synthetic hormones such as estrogen are used in birth control pills. Research shows that the earlier a girl begins to use contraceptives, the greater her risk of breast cancer is.

In essence, over-loaded estrogen in your body may come from the food you eat, the amount of exercise you get, the weight you carry, the place you live and work, and possibly the drugs you take. Elevated estrogen is linked to breast cancer and other cancers. Furthermore, the worst is the harmful impact on the next generations, because their exposure during early life leads to their illness in later life.


Image credit:  by hortongrou

Your BRCA Genes and Breast Cancer Awareness

Pink ribbon w Blue ratio_ctrBy Hui Xie-Zukauskas

We wear pink, especially in October, in honor of those who are currently fighting breast cancer and who died of breast cancer. Altogether, pink is the color associated with breast cancer awareness. For the same reason, I challenge you to go beyond the PINK, by learning a little bit more about how a damaging change in our genes causes breast cancer.

A mutation of BRCA genes has been linked to breast cancer. Indeed, this mutation inherited from either parent allows cancer to grow. Each of us has BRCA1 and BRCA2 genes, have you ever wondered whether or not you carry a mutation in BRCA1 or BRCA2?

Today, let’s get into BRCA mutation 101.

First, what are BRCA1 and BRCA2?

BRCA genes_Basic_CPDBRCA1 and BRCA2 genes are cancer suppressors, i.e. they help fight breast cancer. When either of these genes becomes mutated, it no longer functions properly. As a result of unrepaired DNA damage and impaired genetic integrity, cells are likely growing uncontrolled to develop cancer, just as a car racing on the highway without a brake.

What are harmful effects of BRCA mutation?

For women with BRCA mutation, the lifetime risk of breast cancer is approximately 80%, and chance of ovarian cancers is 54%.

Furthermore, BRCA mutations are also linked to other cancers, including:

  • Women with a BRCA1 mutation are at risk for ovarian cancer and pancreatic cancer.
  • Women with a BRCA2 are at increased risk for melanoma and pancreatic cancer.
  • Other cancer risks: endometrial cancer, colon cancer, etc.
  • Men with BRCA2 mutation are at increased risk of pancreatic cancer, prostate cancer and melanoma.

Who are BRCA1 or BRCA2 mutation carriers?

  1. Young women. Notably, women with a BRCA1 mutation are typically diagnosed with breast cancer at a young age. Approximately one-half of breast cancers occur in BRCA1 mutation carriers before the age of 40.
  2. Both women and men. BRCA is not a sex-linked gene, hence women are not the only BRCA mutation carriers. Men carry BRCA mutation too, although they have a lower risk. A harmful BRCA1 or BRCA2 mutation can be inherited from a person’s mother or father. So, BRCA mutation can pass on without skipping a generation.
  3. Diverse ethnicity. Americans can be BRCA mutation carriers, so can other populations worldwide.

How to detect a BRCA mutation? Pros and Cons?

You can get a genetic screening. Identifying or determining BRCA gene mutation is a blood test. DNA sample for mutation testing can also be obtained from saliva.

Genetic testing may spot unaffected yet high-risk individuals for prevention or closer monitoring, and can help affected women choose the best cancer therapy.

On the other hand, it’s not a routine blood test for public screening. It’s expensive, and takes about a month to get the result. You need to get a genetic counseling and check with an oncologist to make an informed decision.

To conclude

BRCA gene mutations can lead to breast cancer and potentially other cancers. Early detection is the key to saving lives.

Undeniably, breast cancer prevention is for both women and men, and is a year-around practice. We cannot control our genes, but each of us can control or stop an unhealthy lifestyle to reduce cancer risk.


How to Prevent Hereditary Cancer: A Yoga Concept

By Hui Xie-Zukauskas

Do you or your loved ones have any hereditary cancer? Facing hereditary cancer can be challenging. The passing of family members is devastating, and the possibility of getting this “C” makes you feel fearful, sad, frustrated, powerless or even angry. Staying very emotional is understandable, but won’t fix the problem.

Warrior2_IMG_3388-e1360171441431-1024x682Today I’m going to show you one way to stay on top of this horrible “C” – a solution inspired by Yoga Warrior II.

Let’s engage in this yoga pose first. As the warrior II image illustrates, you stretch one arm straight in front and extend the other out behind, with legs and feet stepping apart in a facing-forward position, while your body maintains steadiness and balance, being powered by the leg and core muscles’ strength, with your gaze focusing ahead (just to give an idea for non-yoga goers).

In addition to its physical benefits, the mental or psychological aspect of Warrior II guides you to honor the past, to explore your future, and to strengthen your presence. Angelina Jolie has taken real-life Warrior II actions when facing her risk for hereditary breast cancer. She kept in mind the tragedy of losing her mother to breast cancer, and desires to stay around long for her children and the loved ones. Courageously, she pursued all she could do at the present. Angelina went for a genetic testing to find out her mutated BRCA1 gene, and then underwent a preventive double mastectomy to reduce her high risk of developing breast cancer.

Cancer risk factors come from foods we eat, water we drink, the environment we live, and the genes we inherit; the latter is considered out of our control. What Angelina has done is truly empowering not only for women dealing with hereditary breast cancer, but also for a boarder population; because breast cancer occurs in men too and men do get mastectomy treatment. This conveyed a message that you can take control of your health, including hereditary cancer, by taking preventative measures before it’s too late.

So, what can you do now when it comes to the genetic susceptibility to cancer? Here are 8 practical tips:

1.      Consult your physician and get genetic testing. Genetic counseling is an essential step for any hereditary illness.
2.      Identify a medical or preventive treatment that’s best for you. With the advance of new technologies and therapies, you have more options to choose, which opens up the horizon for your healthy future.
3.      Remember follow-up visit or care whether or not you have had any therapy.
4.      Explore insurance plans for the coverage of your cost. This seems non-therapeutic, but could be a determining factor for many folks to make an informed, life-saving decision.
5.      Cope with any change in your physical body, and manage side effects from your treatment. Keep informed on any related issues.
6.      Seek support when coping with fear, i.e. any fear of cancer diagnosis or cancer recurrence, so as to uphold your emotional well-being, which is vitally important.
7.      Live a healthy lifestyle, refraining from any known cancer risk factors such as tobacco smoking, alcohol, or toxic chemicals and carcinogens.
8.      Enjoy the moment!

See more Cancer and Hereditary Cancer

Image credit: By Brittany Becher