My friend -- who has a friend newly diagnosed with brain cancer -- greeted me at the door the other day and asked with a sense of urgency, "How can I help?"

"Help your friend?" I asked.

"Yes, she said, unsure of what she might say or do in this time of great difficulty for everyone involved.

I told her a few things. And then I thought of some more. It wasn't terribly easy to come up with these ideas. Because even though I myself was on the receiving end of help during my cancer journey, it's still hard to imagine what an individual wants or needs -- or doesn't want or need. But here's what I've got to offer.

I hope this helps my friend.

I hope it helps you too.

• Allow your loved one to take the lead. If you sense this person wants to talk, then talk. If you sense talk is not welcomed, then don't talk. To determine whether or not your friend or family member wants to discuss cancer, approach the topic and judge the response you get. I know I can usually tell if someone is willing to open up -- typically the conversation just flows -- and when someone is putting the brakes on chit-chat -- typically the conversation falls flat.

• If talk is not in the cards, then consider an offer of food. Sometimes actions speak much louder than words. So think about calling a restaurant in your friend's town and ordering a meal to be delivered right to the door. Most eating establishments accept credit card numbers over the phone so location should be a non-issue. Even those deep in despair need to eat, and taking away the chore of cooking and cleaning up can be quite a gift.

• If the gift of food is not up your alley, how about sending a small gift, like a candle, a pair of cozy socks, a grocery store gift card, a music CD, a gift certificate for a spa. You name it, your special something might brighten the day.

• If you live near your loved one and have some free time, offer to drive to appointments, visit during treatments, pick up kids and entertain them for the day, clean house, cook, and clean up dinner. Try to be very specific with your offers. Say, "I'd like to pick up your kids tomorrow at lunch so you can take a nap" or "I'm coming over on Sunday to rake leaves." These offers are easier to accept than the "call me if you need anything" kind.
  

• If a quick stop at your loved one's house is possible, drop off a book on the front porch or set some pretty potted flowers by the door. Or do both. Then walk away without saying a word. Let your help take your friend by surprise.

• When you do have the chance to talk, avoid guiding the conversation with your own thoughts and advice, unless requested. Saying, "Everything will be OK," for example, may not be true. Assuring your friend she will sail right through chemotherapy may backfire if nausea and fatigue are just down the road. Stating, "it's OK, your hair will grow back," doesn't really help those living with the horror of hair loss. So stay away from promises and predictions and stick to the present. Ask questions, listen, and paraphrase back what your friend has shared. These are basic counseling techniques. The premise is that allowing the person to work through the issues is more important than what we can do to directly help.
  

• Don't forget about the good old greeting card or short note that lets your loved know how much you care. Let the card say it if you wish to avoid writing and then add an address, a stamp, and send your support on its way.
  

• This makes eight -- so much for sticking to my Sunday plan -- but I must share this too: Don't forget about your loved one after months and even years pass by. Initial diagnoses are tough and treatments are tough too. But as your friend survives each day, remember to check in. Cancer is a life-long battle for many. Support and assistance may be just as valuable a year down the road as it is on day one.

There may be another explanation for the recently announced decline in breast cancer rates. And it's not nearly as promising as the first explanation may be.

A day after researchers announced that the significant drop in breast cancer cases is primarily due to fewer women using hormone replacement therapy (HRT), some experts suggest breast cancer rates are not dropping at all. Just as many women may have breast cancer, they say. They just aren't being screened for it.

"We have been aware for several years that the number of radiologists who specialize in mammography have been decreasing, and that there are places in the United States where women have difficulty getting access to mammography," Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, wrote on the society's blog just after the public announcement.

"If mammography use has reached a peak and is now decreasing, we may actually be diagnosing fewer cancers when they can be most effectively treated, Lichtenfeld said. "If you don't get a mammogram, you don't diagnose a cancer."

The research linking the decline in HRT to the drop in breast cancer came from the M.D. Anderson Cancer Center in Houston and was discussed at a breast cancer conference in San Antonio on Thursday. The research, based on a report by the National Cancer Institute, showed a seven percent drop in new breast cancer cases between July 2002 and August 2003, corresponding with the results of a 2002 Women's Health Initiative study.

With media reports citing HRT as the direct cause of the drop, some worry the public is getting the wrong message -- specifically women still taking hormones or those who have taken them in the past. While women not taking hormones are breathing a sigh of relief, others are in a panic.

Dr. Katherine Sherif, director of the Drexel Center for Women's Health at Drexel University College of Medicine in Philadelphia, has spoken already with 15 patients worried about this news.

"What I have told them is that three years is too short of a time to measure the effects of a drug on breast cancer," she said. "Cancers take decades to develop, and conversely, withdrawing hormones could not result in a decrease in breast cancer in three years -- it's actually absurdly short." There are also concerns women will experience anxiety about other therapies using estrogen, such as in vitro fertilization (IVF).

The study on HRT and breast cancer may be raising more questions than answers -- which could be a good thing. More questions prompt more investigation, more study, more research. And this will hopefully help us figure out one facet of the mystery of breast cancer.

Previous posts on the topic of HRT and breast cancer are as follows.

• HRT use drops breast cancer rates drop
• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

Breast cancer statistics for 2003 are in, and researchers have announced that the number of breast cancer cases dropped by an impressive seven percent, with the greatest drop occurring in women between ages 50-69 diagnosed with estrogen receptor positive (ER-positive) breast cancer.

The University of Texas M. D. Anderson Cancer Center researchers attribute this good news to the fact that in the same time frame, millions of women stopped taking hormone replacement therapy (HRT) over concerns that HRT led to an increased risk for breast cancer.

If the statistics hold for upcoming years, HRT will have proven a greater causative effect leading to breast cancer than originally believed.

"Incidence of breast cancer had been increasing in the 20 or so years prior to July 2002, and this increase was over and above the known role of screening mammography," stated Donald Berry, Ph.D. "HRT had been proposed as a possible factor, although the magnitude of any HRT effect was not known. Now the possibility that the effect is much greater than originally thought all along is plausible, and that is a remarkable finding."

While the researchers best guesstimate is that HRT might be the contributing factor to the drop in ER-positive breast cancer cases for 2003, they cannot be 100 percent certain at this point. We will need to wait and see what the years 2004 and 2005 tell us about any continuing declines in breast cancer cases, and learn what other, if any, contributing factors are responsible for the decline.

Previous posts we have done regarding HRT and breast cancer:

• Hooray for HRT!?
• HRT and smoking dramatically increases breast cancer risk
• HRT increases breast cancer risks

Cervical cancer was once the most common cancer in women. But between 1955 and 1992, the number of cervical cancer deaths dropped by 74 percent -- thanks to increased use of the Pap test, a screening tool that can find changes in the cervix before cancer develops and can also detect cancer in its most curable stage. The Pap test is still widely used. And the cervical cancer death rate continues to drop four percent every year.

In 2006, about 9,700 new cases of invasive cervical cancer will be diagnosed in the United States. About 3,700 women will die from the disease. Non-invasive cervical cancer is believed to be four times more common than the invasive form of the disease. Nearly all of these cases can be cured.

Cervical cancer typically occurs in women between the ages of 35 and 55 and rarely in women under the age of 20. It affects mostly Hispanic women, and African-American women develop the disease 50 percent more often than non-Hispanic white women. Women most as risk for cervical cancer are smokers, those with HIV or chlamydia infections, those with diets low in fruit and vegetable consumption, those who between 1940 and 1971 took the hormonal drug DES, and those who have taken oral contraceptives for extended periods of time. Women who have had multiple pregnancies, have a family history of the disease, and have a low socio-economic status are also at risk. Those most at risk, however, are women with human papilloma virus.

Human papilloma virus (HPV) is the most common risk factor for cervical cancer, and some experts believe a woman must have HPV to contract cervical cancer. There are 100 different types of HPV, 13 of which are likely to cause cervical cancer through sexual contact. There are usually no symptoms of HPV, but possible signs of cervical cancer can include vaginal bleeding, unusual discharge, pelvic pain, and pain during sexual intercourse.

There are two ways to stop cervical cancer. First, women can protect themselves against HPV. Protection comes in the form of delaying sexual activity, limiting the amount of sexual partners and their partners, using condoms (thought to be 70 percent effective) and receiving the cervical cancer vaccine, recommended for use in females ages 11-26. The vaccine is most effective for women who have never been sexually active. Second, women can receive regular Pap tests in order to catch pre-cancers. Pap tests are recommended for women three years after their first sexual encounter and before the age of 21 -- and then every year after that.

An abnormal Pap test typically prompts a colposcopy -- a technique that uses a scope to examine the cervix. Diagnosis usually stems from a combination of other scoping methods, pelvic exams, imaging tests, and biopsies used to confirm the presence of cancer and to stage the disease. Stages range from 0-4.

For non-invasive cervical cancer, surgery -- ranging from removal of the cancerous tissue to hysterectomy -- may be the only treatment necessary. For invasive forms of the cancer, surgery is often followed by radiation and chemotherapy. Women interested in preserving their fertility should discuss options with their physicians.

The state of cervical cancer has come a long way over the years. And this year, two critical developments emerged. In June 2006, the FDA approved the first drug for late-stage cervical cancer. The drug, Hycamtin, is recommended for use in combination with chemotherapy. Also is June, the cervical cancer vaccine, Gardasil, was released. Both developments are monumental -- and both will undoubtedly help decrease the already-dropping cervical cancer death rate.

For more information about cervical cancer, visit the following sites:

American Cancer Society
Mayo Clinic
Medline Plus
National Women's Health Information Center

If we made no further progress in breast cancer research from this day on, the number of women dying from breast cancer five years from now would still drop substantially because we've progressed so much over the past few years, says MD Eric Winer in the October 2006 issue of Oprah magazine. Winer, director of the Breast Oncology Center at Dana-Farber Cancer Institute and associate professor of medicine at Harvard Medical School, is right. There has been a lot of progress. Breast cancer research is on a roll. And here are seven reasons why.

Stomach cancer is hard to detect. It has no symptoms in its early stages, and there is no effective screening to detect its presence. So early detection and early treatment for this disease -- that attacks 800,000 people worldwide -- are hard to come by. In Taiwan, stomach cancer is the fifth most common cancer and the focus of study for researchers working to devise a method for detecting stomach cancer in its infancy.

A team of researchers at National Taiwan University Hospital have discovered a toxic factor -- GroES -- that causes stomach cancer. And they have discovered that a simple blood test will show either a positive or negative result for this substance, leading to immediate endoscopic exams for patients who may be at risk for stomach cancer. The test to identify GroES has already achieved a 65 percent accuracy rate.

Apparently, if the human body is infected with GroES, it produces antibodies to the factor and can cause chronic inflammation of the stomach, causing cells to rupture and proliferate. Long-term inflammation can cause stomach cancer. Researchers say about 45 percent of adults in Taiwan are infected with GroES -- and one percent will go on to develop stomach cancer.

Right now, patent applications are underway in the United States, Japan, and Taiwan. Once a kit is developed, a single drop of blood will be all it takes to determine the risk for stomach cancer.

I was in the emergency room the other night with my three-year-old who was experiencing a mysterious leg pain that resulted from a bad case of strep throat. It wasn't serious enough to warrant swift movement from the waiting room to an actual room and we sat in a holding pattern with a crowd of other patients, some of whom were still waiting after Danny had been treated and released. I was told patients are served in the order in which they arrive but also according to the seriousness of their complaints -- which takes me back to the night I was in the ER with a fever, headache, sore throat, and sore gums. The night I was given a mask and was immediately escorted from the waiting room to a private room where doctors and nurses treated me for neutropenia -- a condition caused by chemotherapy and marked by a drop in neutrophil levels, a condition that puts chemotherapy patients at great risk for infection. This was the second time I went to the hospital for neutropenia. Both times I was admitted and treated for five days.

And so sitting in the ER reminded me about how serious chemotherapy side effects can be. And it makes me want to caution all chemotherapy patients to never dismiss the signs that the body is suffering -- to never tough it out with the hope that a good night's sleep or a few days rest will straighten everything out. Because it may not -- and the end result may be tragic.

All chemotherapy patients should be briefed by their medical teams about when to call for medical assistance. For me, a temperature of 100.4 was the magic call-for-help signal. And twice, I called for help -- once in the middle of the night. But any symptoms , and definitely a combination of symptoms, are cause enough for a simple phone call. So don't delay. Don't excuse warning signs that your body is struggling. Don't second-guess your decision to notify a medical professional about your symptoms. Just call. It could save your life.

Older colon cancer patients are not completing the recommended course of chemotherapy treatment, and a new study suggests it might be because there is a need for social and physical support not currently offered to the elderly. In addition, other factors attributed to these patients dropping out of treatment are physical frailty and treatment complications. Chemotherapy is no walk in the park at any age, but if you are elderly, and do not have strong social support or someone to help you physically as needed to tend to the daily tasks of life, getting through treatment must be a horribly lonely and hopeless experience. Research indicates that patients who completed chemotherapy had a reduced risk of death. The authors of this study recommend interventions to improve social and physical support throughout the treatment course could be implemented to test whether such support improves rates of chemotherapy completion in elderly colon cancer patients. From a simply compassionate and common sense point of view, it should be obvious that we need to be there for the elderly citizens in our community in every way they need us to be there -- especially if they are struggling through cancer treatment.