4/4/15 @BRCAresponder WEEKLY "ANGELINA EDITION"

Updated post: 4/15/15 INTERVIEWS "Angelina Advocacy Effect"

"ANGELINA ADVOCACY EFFECT" 
@BRCAresponder after Angelina Op-Ed #2

A fellow BRCA advocate reached out to me and asked me for tips on doing interviews surrounding Angelina's latest op-ed and BRCA/hereditary cancer.  I thought this was a great opportunity to share these tips in a blog post for others doing interviews. My interviews following Jolie's 2nd op-ed are listed here as well.
XO Amy @BRCAresponder 

1. Be yourself!

2. If you are on going to be on television, wear something you are comfortable in, more fitted, not oversized, plus a good solid color. Avoid busy prints or the color green--not best for television. 
* even if you are a no-makeup person, television studio lights can really wash you out.  Wearing just a bit of HD foundation and HD powder, and blush or bronzer will really help you just look more like yourself on television. Not confident in your makeup application skills? Tip: just mix a dime size drop or less of foundation with your regular moisturizer! Let dry a few minutes before dusting of setting powder and your bronzer. 
3.  Have 1-2 key points in your head that you really want to get across no matter what interview questions are asked.
4.  For me, I always stress the importance of genetic counseling in the genetic testing equation in EVERY interview.
5. LISTEN to what the interviewer is asking you and know that your answer really has an opportunity to educate, save lives, empower.
6.  Refrain from using words like "should"- or "you should" or any judgement of others' cancer risk management choices. Everyone is different. Do your best to not say "UM". Practicing key points in advance can help avoid this.
****7.  Make sure you know the facts/science behind BRCA/Hereditary cancer and state those-not your opinion. Do your best to encourage the television station/producer/ interviewer that it is really smart that you be joined by an expert in GENETICS. The National Society of Genetic Counselors , or a breast surgeon, gynecological oncologist, or oncologist extremely familiar with BRCA/Hereditary cancer. *Language is very important. Say, recommendations as per research (science)… or my experience was...
8.  Talk about facts and/or your story w/compassion and passion.
9.  Breathe
10.  Be confident, you are educating and saving lives with your interview.
11.  You are the expert of your own experience. 
12.  You can do it, you are amazing, embrace your opportunity in the spotlight!

_____________________

"ANGELINA ADVOCACY EFFECT" 

@BRCAresponder in the news after Angelina Op-Ed #2

3/24/15 @BRCAresponder on 
@WPTV news 
web chat transcript

&

2 ARTICLES

@BRCAresponder featured in:  

"Angelina Jolie Pitt reveals she had ovaries removed -The actress has the BRCA1 mutation, which puts her at high risk for breast and ovarian cancer"     

March 24, 2015 | By Diane Mapes / Fred Hutch News Service

"Understanding Angelina Jolie Pitt's medical choices        Actress, filmmaker lauded for raising awareness and saving lives, but her actions also bring up questions"        March 25, 2015 |By Diane Mapes / Fred Hutch News Service

@BRCAresponder/ONCOLOGY NURSING NEWS

@BRCAresponder/EPISODE OF THE CANCER WARRIOR

@BRCAresponder featured in 

BLOGPOST, RADIO SHOW, CURE MAGAZINE

MY GENE COUNSEL
The power of ‪health care consumers should not be 

underestimated

RADIO SHOW 4/13/15 

Angelina Jolie shares the next chapter of her BRCA mutation story, with @BRCAresponder @GeneticCouns president http://t.co/VCI9leKnuW

— CURE Magazine (@cure_magazine) April 9, 2015

THE JEWISH STANCE ON CANCER RISK MANAGEMENT- IS IT THE SAME AS VACCINATION?

Recently I have been struck by the many pieces written by various Rabbi's addressing the "Jewish stance" on vaccination.

Rabbi Jeffrey Salkin
Rabbi Rebecca Einstein Schorr 
Rabbi Jason Miller
Rabbi Dan Dorsch

STATEMENTS ON VACCINATIONS FROM THE OU & RABBINICAL COUNCIL OF AMERICA 

Various quotes: "It's a parental 
responsibility" "It's a mitzvah" "Judaism places the highest value on preserving human life" 
I was particularly struck by the following:
(from Rabbi Jeffrey Salkin's piece Jewish anti-vaxxers take note: Parental responsibility trumps parental rights)

• You’re not allowed to endanger yourself needlessly. The Shulchan Arukh, the classic code of Jewish law, says: “Wherever there is a potentially life-endangering pitfall or obstacle, it is a positive commandment to remove it, to be on guard against it and to take very good care in the matter, as the Torah says: “Guard yourself and guard your soul.” (Deuteronomy 4:9-10).

Is this "Jewish take" the same when it comes to decisions surrounding cancer risk management decision making? Meaning: for those at a VERY high risk for cancer due a hereditary cancer gene mutation is the "Jewish stance" that a person SHOULD HAVE prophylactic surgeries that would drastically reduce their cancer risk? And, if so which prophylactic surgeries? How does science, healthcare and/or cancer risk percentages come into play when interpreting Jewish Law? Or how does Jewish Law come into play when interpreting healthcare, cancer risk percentages, & science? 1 in 40 Jewish people carry a BRCA gene mutation. In addition, there are MANY, MANY other hereditary cancer syndromes. There are different ramifications and percentages surrounding hereditary cancer risk for men and women. For example, should men who carry a gene mutation that puts them at higher risk for breast cancer--should these men be having a preventive mastectomy too?  How much percentage of risk constitutes parental responsibility or a "potentially life endangering pitfall"? Does the cancer risk percentage matter? Where does Jewish Law draw the line? If a person has an increased risk for cancer, even if the number is small and one chooses to reduce that risk with a prophylactic surgery --is it a positive commandment to remove it, to be on guard against it? 

Does Jewish Law even have an answer for this? Is cancer risk management decision making too intricate a subject with too many variables for Jewish Law to even have a position?

Finally, is there a different posture in Judaism regarding a woman's parental responsibility and a man's parental responsibility? Are there different postures within the reform, conservative, and orthodox communities?

I have more questions than answers. Jewish scholars and Rabbi's where should I stand on this subject? Parental responsibility was definitely a huge influence on my own cancer risk management decisions.

As a hereditary cancer/BRCA health advocate I always stress to others that what is right for one person may not be right for another. 

I often say, "While preventive surgery was right for me it may not be what is right for you and there are other less invasive options you can do to reduce your cancer risk." (please note that these other options I am referring to do not drastically reduce hereditary cancer risk like preventive surgeries do)

It's Friday night and my parental responsibility tells me I need to turn off the computer and be with my kids. I know that is right. But as I turn off electronics I am thinking about the parallels between vaccination decisions and cancer risk management decisions. As a Jewish woman, health advocate, and parent…am I right in advising others that they have "other" options than prophylactic surgery to reduce their hereditary cancer risk? According to Jewish Law, am I wrong?


SHABBAT SHALOM

2/6/15 @BRCAresponder WEEKLY

GOT STAMPS?



Pink & Blue POSTAGE STAMPS #2 by PinkBluedocumentary
Create custom usps stamps.

Pink & Blue POSTAGE STAMPS by PinkBluedocumentary
Browse Pink Stamps

Happy Holidays! XO @BRCAresponder

TO REMAIN BREATHING

Updated 12/17/14:   RIP Annie Goodman. I tweeted with Annie back in March. I have included that interaction below.I dedicate this blogpost to Annie as "she wanted to bring attention so more women wouldn't have to follow her." Annie Goodman was BRCA1 positive and had triple negative breast cancer. She passed away today at only 33 years old--the same age my grandmother Lillian passed away in 1934. 

@BRCAresponder no did not know about BRCA status til after diagnosis. First to get bc in my family. My father has mutation
— Annie Goodman (@annieg917) March 7, 2014

@BRCAresponder 

You may not understand everything surrounding increased cancer risk. If you have a family member or friend diagnosed with a BRCA gene mutation, other genetic mutation, or diagnosed as high risk for certain cancers, please read this. My hope is that this post will inform and enlighten you about increased cancer risk and cancer risk management decisions.

Research studies, scientific abstracts, The "Angelina Effect", the "Etheridge controversy"... 

The research, the news articles, the conversation--it's all good. BRCA gene mutations are getting attention. 

But, let's bring it back to earth for a moment. It's important that there is some tangible perspective on what dealing with an increased risk for cancer actually FEELS like to an individual; a not so gentle reminder that there are people everyday learning that they carry a BRCA gene mutation, other genetic mutation, or a genetic variant of unknown significance. There are some people living with an increased risk for certain cancers simply due to their family medical history. There is no "one size fits all" approach. Cancer risk and cancer risk management is highly patient specific. What is clear for individuals with increased risk for certain cancers, is that there are heavy decisions surrounding cancer risk management. 

Everyone has their own personal experiences and beliefs that go into their own cancer risk management decision making process. I want to share some of my thoughts in my own decision making process. I'm hoping it will educate and enlighten others on how deeply personal these risk management decisions are plus the many, many layers that can go into the hereditary cancer risk management decision making process.  

GOT RISK? 

For me, the bottom line was: 

I wanted to remain breathing--I wanted to be alive, to live.

I made my personal decision to have preventative surgeries (bilateral prophylactic mastectomy PBM and reconstruction and prophylactic oophorectomy -BSO-bilateral salpingo oophorectomy plus hysterectomy removal of the uterus) based on MANY factors...here are JUST 18 reasons I made my very personal decision:

 1) I carry a BRCA1 genetic mutation & the science indicates I have a very high risk for cancer. I educated myself and learned that these surgeries were currently the best chance/best option I had at DRASTICALLY reducing my breast cancer and ovarian cancer risk. As a BRCA positive woman, it was my best chance for "a cure".

 2) the actual large pattern of MANY breast and ovarian cancers in my family-with many deaths at YOUNG ages 

 3) I previously had a benign brain tumor; a very intense experience both physically & emotionally -- I decided I did not want to EVER go through an actual cancer diagnosis if I could help it. I was already having brain scans every few years. I saw a life before me of brain scans and boob scans. I did not want that to be my existence, my life.

 4) seeing my sister on the ground in the relentless, death pain of ovarian cancer. 

 5) watching my dear friend Kristin (also BRCA1 pos.) go through triple negative breast cancer (very difficult to treat) , radiation, chemotherapy, and then die at age 42 leaving behind her young daughter and husband. 

Kristin

My grandmother

6) knowing the research shows that BRCA1 carriers tend to get triple negative (very difficult to treat) breast cancer - I had no interest in having triple negative breast cancer or any kind of breast cancer ever if I could help it 

7) having utmost confidence in my breast surgeon and plastic surgeon, both knowledgable about BRCA mutations. 

8) Knowing my grandmother died at 33 years old of breast cancer in 1934 & having the knowledge that her fate did not have to be mine 

9) not wanting to live with constant anxiety- anticipating my next MRI's, mammograms, ultrasounds. I didn't want to live a life of anxiety.

10) Knowing that there are no accurate surveillance methods for ovarian cancer 

11) My sister had uterine cancer in addition to ovarian cancer...and then went on to get breast cancer 

Me & My Sister

12) A nipple sparing, skin sparing bilateral mastectomy with reconstruction can be a one-step surgery--the nipple and skin remains intact. Reconstruction has come a long way. It's just fat and tissue I thought--& who needs fat and tissue if it can kill you! Let's replace that stuffing so I can live. 

13) the anxiety of constantly touching my breasts to feel for lumps 

14) I did not want to go through chemotherapy if I could help it 

15) Knowing I needed to be here for my kids 

16) I needed to be here for my husband 

17) I needed to be here for me 

18) I needed to live, to be alive; to remain breathing.

@BRCAresponder 

Amy Byer Shainman

BRCA 1 positive, previvor

BRCA/Hereditary Cancer Health Advocate

*Everyone is different. Cancer risk management is highly personal and highly patient specific.  What is right for one person may not be right for another. Always do your own research and consult with your own medical professionals. 

Find a Genetic Counselor: 

www.nsgc.org

OR

www.informeddna.com 

Follow Amy's board Hereditary Cancer & BRCA Awareness on Pinterest.

Where are we now? Almost 2 years later, a follow up to the 2013 Cure Magazine Article "Risk Management: Living in the Past, Present and Future with Genetic Risk"

Our grandmother Lillian Byer
Lillian died September 23, 1934 
She was 33 years old.

Since 2013, thankfully, both my sister Jan and I remain healthy. We both monitor ourselves regularly with various doctor's appointments. Even though I underwent a prophylactic nipple-sparing, skin sparing, bilateral mastectomy with reconstruction plus a complete hysterectomy (both in 2010), I still see a high risk oncologist every 6 months. My oncologist gives me a manual breast exam, regular blood tests (which include a CA-125 blood marker test), and she also monitors my bone density. My oncologist also sent me for my first colonoscopy; making sure I went to a gastroenterologist who is knowledgeable about BRCA mutations and hereditary cancer risk.

This blog post is a follow up to the 2013 Cure Magazine article:                                                          "Risk Management: Living in the Past, Present and Future with Genetic Risk"  2013

When I look at this recent picture of me & my sister below…it's hard for me to believe how much we have both been through medically. I would bet that no one would be able to tell from this picture that my beautiful sister Jan is an ovarian, uterine, AND breast cancer survivor. In addition, that she endured almost 10 surgeries alone just to deal with the breast reconstruction issues that she encountered.

SISTERS… happy, healthy, and celebrating at my daughter's Bat Mitzvah 
November 22, 2014

As for my BRCA/Hereditary Cancer advocacy, this past year I've taken it to a new level.  Branding myself as The BRCA Responder, I use social media to disseminate BRCA/Hereditary Cancer information and education. I came up with the name The BRCA Responder because I tend to "not keep very quiet" regarding all things BRCA and Hereditary Cancer.  I tend to "respond" to online cancer articles- constantly, incessantly, passionately. Furthermore, I inherited my BRCA1 gene mutation from my Dad. When I was younger and my Dad would yell out for me to see where I was, he would always follow up by then saying, "Amy, PLEASE RESPOND!" So, Dad helped me in becoming quite the "Responder." 

It just made sense: The BRCA Responder.

Please follow me on twitter @BRCAresponder

I find twitter to be an extremely effective social media platform. It's a great way to get important information out to the world immediately, in real time. I tweet and RT the latest BRCA/HEREDITARY CANCER research, studies, stories, and more. Tweet chats are also a great way to connect with the medical community and patients. #BRCA  #bcsm #gyncsm are just some twitter hashtags providing great discussion and information. 

Every week I distribute my own online BRCA/HEREDITARY CANCER news--@BRCAresponder WEEKLY. It's an online weekly news of everything happening with BRCA/HEREDITARY CANCER. I scour the internet and all forms of social media for everything current on BRCA/HEREDITARY CANCER. There are many cancer stories out there but my goal is to include information in the news that is most relevant to the BRCA/HEREDITARY CANCER community. I include current research, studies, personal stories of hereditary breast and ovarian cancer, upcoming BRCA conferences and webinars, information on genetic counseling, genetic testing, gene patenting, and really whatever is "news" in BRCA/HIGH CANCER RISK/HEREDITARY CANCER for that particular week.  

On this, my blog, I repost weekly news and my opinions, plus anything else in the BRCA/HEREDITARY CANCER realm that I feel is especially "important" to highlight.  I view myself as a connector of the dots, a facilitator, a go-between, an ambassador of knowledge…gathering accurate BRCA/HEREDITARY CANCER information together in a cohesive way to inform others. 
The ultimate goal: saving lives. 

Social media is an excellent way to provide ongoing, immediate support to others. 
I am proud to be a Co-Administrator of the BRCA Sisterhood. Fellow advocates and friends Karen Lazarovitz and Teri Smieja started this private online Facebook group for women only. At over 4000 members, the BRCA SISTERHOOD is the largest private online Facebook group for women only that are HIGH RISK/affected by BRCA/HEREDITARY CANCER. 

The male counterpart is THE BRCA BROTHERHOOD.  

These groups provide wonderful support.

Currently, I'm most excited about the documentary film PINK & BLUE www.pinkandbluemovie.com

The official movie poster for PINK &BLUE 

Alan Blassberg, Pink & Blue director 

While on Facebook one day, I saw a post about the film and soon realized that the filmmaker Alan Blassberg and I had a mutual friend. I reached out to Alan and the rest is history--I signed on as Executive Producer.
Alan and I both carry a BRCA gene mutation (Me: BRCA1 and Alan is BRCA2) and each of us have lost too many family members to BRCA associated cancers. Alan and I soon found that we both share the same vision for education and knowledge surrounding BRCA gene mutations and Hereditary Cancer. We are both extremely passionate about providing information about the male side of things, particularly male breast cancer. Both women AND men can pass down a BRCA gene mutation to daughters AND sons. 

The Pink & Blue crew with BRCA1 positive Kelly Rothe &
 Detroit Red Wings  Jimmy Howard 

www.pinkandbluemovie.com 

We want to bring the blue out from the shadows of the "pink." This past October "PINKTOBER", as I found myself drowning in the sea of pink, I was compelled to produce a 2 minute video called "It's not just PINK" to educate the public about male breast cancer. 

PINK & BLUE Director Alan Blassberg. Blassberg, BRCA 2 positive, lost his sister Sammy and many other family members to BRCA related cancers. 

Alan is shown here getting a mammogram. 

(Blassberg wonders where are the robes with BLUE breast cancer ribbons?) 

Sammy

Blassberg was recently named one of The Jewish Daily Forward's
 "FORWARD 50" -  2014

Working with Alan on PINK AND BLUE has been beyond an amazing experience and collaboration. Increasingly people are starting to hear about BRCA gene mutations and what inheriting a BRCA gene mutation can mean for their health and their family.

Although I continue to work hard everyday, Angelina Jolie's "announcement" last year and op-ed piece in the New York Times did in one day what I couldn't even begin to achieve in my lifetime. In that one day, Jolie brought global attention to the words BRCA, BRCA mutation, and double mastectomy. Jolie brought specific awareness to those words and according to recent research also a definite increase in those seeking genetic testing.  

However, understanding issues surrounding BRCA mutations and cancer risk are complex. Breast Cancer Awareness is definitely out there--what's missing is actual Breast Cancer Education.  For example, many journalists do not "get" exactly how to address breast cancer risk in a story. I am not blaming them--hereditary cancer and cancer risk is extremely intricate. Many doctors are still uneducated on the subject. During the filming of Pink & Blue we have talked with many people who have been the ones to actually educate their own doctors on BRCA 1,2 and male breast cancer. 

Where to start with cancer risk education? A good place to start with BRCA/HEREDITARY CANCER education would be at the ground floor level--at the medical schools and with the physicians. Regular doctors (not certified genetic counselors or genetic experts) currently offering BRCA testing should also be required to pass certain cancer risk assessment requirements when they are up at their medical review board. There are so many hereditary cancer syndromes and gene mutations beyond BRCA. How does a doctor who is not a trained expert in genetics qualified to give a thorough cancer risk assessment, give one? Well, unfortunately, often times they don't. Primary care doctors are not routinely implementing or trained in evidence based decision making for genetic testing or counseling.

What I try to do in my advocacy work is to reach out to both journalists and doctors and give them a cheat sheet. This cheat sheet format works particularly well on social media. People shouldn’t panic and hide when they hear “BRCA gene” or “gene mutation”; that includes medical professionals. The work of scientist Dr. Mary Claire King proved many people wrong. King’s discovery of the BRCA1 gene and scientific research of 20 plus years has saved and will continue to save countless lives. 

Here is one simple way to see if you might want to talk with a genetic counselor. 

I also ask journalists to please use resources and reach out to a genetics expert on each cancer story that comes their way. This way, if a story seems to have a genetic component, that information will not be omitted from the piece. I have seen all too often stories where there are 3 generations affected by breast cancer and there is not one mention anywhere of genetics, genetic counseling, or genetic testing.  The reader is "aware" that this is a breast cancer story but not educated about why 3 generations have all been diagnosed with breast cancer. It becomes a missed opportunity to educate…which is ultimately a missed opportunity for true "awareness"; a missed opportunity to save lives.

I completely understand Angelina Jolie's very personal decision to have a prophylactic mastectomy. Even more, I completely get why she made her story public with an "announcement" in the New York Times . I also get why Jolie continues to be open and be public about her BRCA mutation status and risk management decisions: Empowerment and Saving lives. I think if you are a strong, independent, empowered woman like Angelina it is probably hard to keep quiet once you have received accurate genetic counseling/education about the danger of BRCA gene mutations and seen the scientific evidence.
In addition, if you are a strong, independent, empowered woman, plus a humanitarian who happens to be a global celebrity…AND in addition to the scientific evidence and genetics education you have ALSO personally experienced BRCA’s wrath (the death and devastation in your family of BRCA related cancers), I would bet you probably couldn't live with yourself if you DID NOT share the lifesaving knowledge. 

"I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options."  Angelina Jolie 

I encourage every journalist who writes an article about Angelina Jolie, to make sure they get the facts on BRCA; consult with genetics experts. If journalists do this...there will be a trickle down effect--many, many lives will be saved. 

So, everything on Angelina Jolie--I completely get it. I do what I do because in part, I could not live with myself if I remained quiet. Sitting on this gold nugget of lifesaving knowledge, I am compelled to stand up and speak out often sharing my own BRCA story regularly. Most recently I shared my BRCA story at a cancer genetics “lunch & learn” at Jupiter Medical Center.

Sharing my BRCA story at Jupiter Medical Center  Oct. 2014

PINK & BLUE director Alan Blassberg has such a unique vision for storytelling that while Angelina made us BRCA "aware", PINK & BLUE will continue on and provide BRCA "education."  Blassberg and I have already filmed interviews from world renowned breast surgeons, oncologists, genetics experts, plus many stories illustrating the complicated decision making process surrounding BRCA and cancer risk management. I am certain PINK & BLUE will enlighten people on BRCA/HEREDITARY CANCER with storytelling, education, and science. Cancer doesn’t have a set path. Everyone has a different journey. PINK & BLUE really looks at the personal decisions people make. There is no right or wrong in all of this. Jolie’s Op Ed demonstrated that. Every decision around BRCA/HEREDITARY CANCER is highly personal and highly patient specific. What is right for one person may not be right for another. 

My big hope is that research on BRCA/HEREDITARY CANCER will allow future generations to have less invasive cancer risk management options to them.  Selfishly, I want this for my young son and teenage daughter who each have a 50/50 chance of inheriting my same BRCA1 gene mutation. 

There needs to be a HUGE SHIFT from "awareness" to "education"--from the ground floor at the medical schools, to the media, to the general community, all the way up to the NFL. 

My focus on PINK & BLUE, my daily advocacy, and daily family life has delayed the release of my BRCA memoir "Resurrection Lily." However, my memoir WILL be out in 2015 shortly after the release of PINK & BLUE. Stay tuned for both. I will surely be blogging and tweeting constantly, incessantly, and passionately about both releases. 

Amy Byer Shainman

The BRCA Responder  twitter.com/brcaresponder  @BRCAresponder

BRCA HEREDITARY CANCER HEALTH ADVOCATE, BRCA1 Positive Previvor

@BRCAresponder WEEKLY: http://storify.com/BRCAresponder

BLOG: thebrcaresponder.blogspot.com

PINK & BLUE www.pinkandbluemovie.com

@pinkandbluedoc