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How Siteman approaches triple-negative breast cancer treatment

According to the American Cancer Society (ACS), triple-negative breast cancer (TNBC) accounts for 10-15 percent of all breast cancers. It develops more quickly, is more likely to spread and is harder to treat than other breast cancers. Because it’s such an aggressive cancer, TNBC has a poorer prognosis than other invasive breast cancers.

What is triple-negative breast cancer?

Triple-negative breast cancer is a type of breast cancer whose cells have tested negative for estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor 2 (HER2). Unlike other invasive breast cancers, TNBC does not respond to hormone therapy or therapies that target HER2.

Diagnosed with triple-negative breast cancer? You’re not alone.

If you have recently received a TNBC diagnosis, you likely feel a great deal of fear. Common fears that TNBC patients have include:

  • Lack of targeted drug treatments
  • Treatment not working
  • Cancer recurrence
  • Dying

While a TNBC diagnosis can be scary, remember that it is not a death sentence. There are effective treatments for this cancer and many women go on to beat TNBC and live full lives, cancer-free. The earlier the cancer is caught, the easier it is to treat. This is why mammograms and early detection are so important.

Survival rates for triple-negative breast cancer

Survival rates for TNBC depend on how far the disease has progressed. According to the ACS, 5-year survival rates are as follows:

  • Localized (contained to the breast): 91 percent
  • Regional (spread outside the breast to nearby structures or lymph nodes): 65 percent
  • Distant (spread to distant parts of the body such as lungs, liver or bones): 12 percent
  • All stages combined: 77 percent

It’s important to keep in mind that survival rate statistics for TNBC are an estimate. Your experience as a TNBC patient is unique, and statistics reflect outcomes of previous patients and past treatments. Speak with your doctor about your specific situation and what your prognosis looks like.

The Siteman approach

With expert physicians, skilled support staff and the latest technology, we give our TNBC patients the comprehensive care they need to fight their cancer. In addition to clinical care, our researchers are making strides in developing ways to use the body’s immune system to fight breast cancer, including vaccines.

TNBC treatment options at Siteman

As a TNBC patient, making treatment decisions can be stressful. At Siteman, our exceptional providers offer a variety of triple-negative breast cancer treatment options:

  • Surgery: oftentimes, patients first need to have either the lump removed (lumpectomy) or the entire breast removed (mastectomy). Then, they will receive chemotherapy to target any remaining cancer cells.
  • Chemotherapy: because hormone therapy and HER2 drugs aren’t effective treatment options for women with TNBC, chemotherapy is the main systemic treatment option. Patients may receive chemo prior to surgery (neoadjuvant chemo), either by itself or with pembrolizumab to shrink a large tumor. Patients may also receive chemo after surgery (adjuvant chemo) to reduce the chances of recurrence.
  • Targeted drugs: for women with TNBC who have a BRCA mutation and whose cancer no longer responds to more common breast cancer chemo drugs, their treatment teams may turn to other chemo drugs (such as carboplatin) or targeted drugs (called PARP inhibitors).
  • Radiation therapy: radiation usually comes after lumpectomies or mastectomies. High-energy radiation targets the breast to kill any remaining cancer cells. The process takes about 20 minutes. Most women receive radiation four to five days a week for about six weeks.

Populations at increased risk for TNBC

There are certain risk factors that put a woman at greater risk for TNBC. You may be at increased risk if:

There are many factors that contribute to these racial disparities that are still unknown. However, Black and Hispanic patients are more likely to have unsatisfying communication with their doctors, experience discrimination in health-care settings and have a harder time getting to and from their appointments.

Clinical trials for TNBC

Clinical trials are often used for triple-negative breast cancer treatment. Prior to taking part in a clinical trial, patients will first undergo standard treatments. However, if those treatments haven’t been successful, patients may choose to take part in a clinical trial in the hopes of a better outcome. If you are a TNBC patient interested in participating in a specific clinical trial, please speak with your physician about the trial.

The choice to participate in a clinical trial is highly personal, and one you should make after speaking with your provider about potential benefits and risks. While most health insurance plans cover clinical trials, make sure to first verify your coverage with your insurance carrier.

Our breast cancer specialists

The breast cancer specialist team at Siteman comprises outstanding Washington University medical oncologists, radiation oncologists, surgeons, radiologists, geneticists and psychologists. The diverse expertise of our specialists is what allows them to create individualized treatment plans for all triple-negative breast cancer patients.

Success among Siteman triple-negative breast cancer patients

In 2016, when Celina Campbell found a quarter-sized lump in her breast, she assumed it was just a swollen area due to a minor injury. However, breast cancer runs in Celina’s family and her cousin had just received a TNBC diagnosis. Because of this, she began to suspect the lump could be cancer. After following up with a breast surgeon, it was indeed confirmed that Celina, too, had TNBC.

While triple-negative breast cancer treatment was very emotionally and physically draining, Celina remained determined to overcome her diagnosis. And, after eight sessions of chemotherapy, no more lump could be found. Now, six years later, Celina lives a full life and her cancer is considered fully cured.

Throughout her cancer journey, Celina received the most exceptional care and support from Siteman’s breast cancer specialist team. Former Washington University medical oncologist William Popovic, MD, laid out a thorough and personalized treatment plan for Celina, putting her at ease with his warm demeanor and genuine concern. All of the staff dedicated themselves fully to Celina’s journey, always working to help her understand her cancer and her treatment. The expertise, commitment and compassion of Washington University breast cancer specialists at Siteman allowed Celina to take charge of her life and to become an incredible inspiration to other TNBC patients.

Patient support

In addition to providing unmatched clinical care, Siteman provides compassionate support to help each and every patient cope with the emotional and physical tolls of cancer treatment.

  • Nurses: specially trained to help breast cancer patients cope with symptoms, treatment and side effects.
  • Nurse navigators: clinically trained to provide guidance and answer questions at any point.
  • Registered dietitians: provide guidance about nutrition and meals or snacks that will be good for you as you move through treatment.
  • Psychologists: provide free mental health care for you and your family members.
  • Palliative care specialists: provide support to help you manage pain and other side effects of your treatments.

You’ve been diagnosed with triple-negative breast cancer. Now what?

If you’ve received a TNBC diagnosis, you may be experiencing a range of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms that may point to breast cancer, or if you have received a TNBC diagnosis and would like a second opinion from a breast cancer specialist at Siteman, please call 800-600-3606.

How Siteman approaches metastatic breast cancer treatment

Finding out you have metastatic breast cancer (also known as advanced or stage IV breast cancer) can be very scary. While there is no cure, treatment can slow the cancer, extend the patient’s life and improve quality of life.

What is metastatic breast cancer?

Metastatic breast cancer refers to cancer that originated in the breast and has spread to another part of the body. First, cancer cells break away from the original tumor in the breast. Then, they travel through the bloodstream or lymphatic system to other parts of the body. When breast cancer spreads, it most commonly does so to the liver, brain, bones, lymph nodes or lungs.

Which breast cancers are most likely to metastasize?

All breast cancers have the potential to metastasize. However, human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancers are more aggressive. For this reason, these types of breast cancer are more likely to spread than others.

Afraid of your metastatic breast cancer diagnosis? You’re not alone.

If you or a loved one has recently been diagnosed with metastatic breast cancer, you may be feeling a great deal of fear. Common fears of stage IV breast cancer patients include:

  • Fear of cancer progression
  • Making treatment decisions
  • Worry about loved ones
  • Uncertainty about the future
  • Financial pressures
  • Dying

Your fears and concerns are surely valid. Still, it is important to remember that many metastatic breast cancer patients continue to live full and meaningful lives. Siteman breast cancer specialists are here to provide you with only the most exceptional care to give you the best possible chances for a positive outcome.

Risk factors for metastatic breast cancer

Although all breast cancers have the potential to spread, there are certain factors that increase the chances of that happening. These include:

  • Previous breast cancer diagnosis
  • Type of cancer (HER2-positive or triple-negative)

Metastatic breast cancer survival rates

Breast cancer is the second leading cause of cancer death in women, with metastatic breast cancer causing the vast majority of those deaths. According to the American Cancer Society (ACS), the five-year survival rate for women with metastatic breast cancer is 28 percent. For men with metastatic breast cancer, that rate is 22 percent.

While these statistics may seem daunting, keep in mind that metastatic breast cancer is treatable at any stage. What’s more, treatments are continuously improving and have proven to help metastatic breast cancer patients live longer and more fulfilling lives.

Bone metastasis and pain management

Breast cancer can spread to any area of the body. However, breast cancer most often metastasizes in the bones. Bone metastases affect more than half of women who develop stage IV breast cancer. The most common sites of bone metastasis are the ribs, spine, pelvis and long bones in the arms and legs.

Patients with bone metastases are at risk of bone fractures, spinal cord compression and bone pain. This pain tends to be constant. It may get worse with physical activity and usually doesn’t go way with rest. As a result, sleeping can be difficult.

The good news is that there are drugs that can reduce these symptoms by strengthening and protecting your bones. There are many benefits to these drugs for those suffering from bone metastasis. These include:

  • Reduced pain due to bone metastasis
  • Lower risk of bone fractures
  • Reduced need for surgery to repair bone fractures
  • Reduced need for radiation to treat bone pain
  • Blocked progression of bone metastasis

The Siteman approach to metastatic breast cancer

With expert physicians, skilled support staff and the latest technology, we ensure that our metastatic breast cancer patients receive the comprehensive care they need. In addition to clinical care, our researchers are making strides in developing ways to use the body’s immune system to fight breast cancer, including vaccines.

Siteman conducts more clinical trials than any other cancer center in the region. Several new drugs have emerged from our clinical studies that have had a promising impact on metastatic breast cancer. Meanwhile, more and more innovative breast cancer drugs continue to be developed.

Metastatic breast cancer treatment options

Washington University breast cancer specialists at Siteman offer the following treatment options for all types of metastatic breast cancer.

  • Chemotherapy: to destroy as many cancer cells as possible
  • Radiation therapy: to relieve or control pain in a specific area
  • Hormone therapy: to shrink or slow the growth of hormone receptor-positive metastatic breast cancer
  • Targeted therapy: to target specific characteristics of cancer cells, such as proteins that foster cancer cell growth
  • Surgery: to prevent broken bones or cell blockages in the liver

The type of treatment you receive will depend on the type of breast cancer that you have.

Hormone therapy for metastatic breast cancer

Hormone therapy differs based on the hormone receptor (HR) status and the human epidermal growth factor receptor 2 (HER2) status of your cancer. For example:

HR-positive – If you have estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+) breast cancer, hormone therapy will likely be the first treatment you’ll receive. Hormone therapy drugs lower estrogen levels or block estrogen receptors. Hormone receptor-positive cancers tend to grow more slowly than hormone receptor-negative cancers.

HR-negative – This type of breast cancer doesn’t have any hormone receptors. For this reason, the cancer won’t be affected by treatments intended to block hormones in the body. Instead of hormone therapy, chemotherapy is the main treatment for hormone receptor-negative breast cancers.

HER2-positive – This type of breast cancer involves an overabundance of HER2, a protein that promotes the growth of cancer cells. Treatment for HER2-positive breast cancers involves a combination of chemotherapy and drugs that target the HER2 proteins. These drugs block the HER2 receptors from receiving growth signals in order to slow or stop the growth of the cancer. HER2-positive cancers tend to be more aggressive than HER2-negative cancers.

HER2-negative – This type of breast cancer involves cancer cells that have a small amount or none of the HER2 protein. HER2-negative cancer cells may grow more slowly and are less likely to come back or spread than HER2-positive cancer cells. If your cancer is HER2-negative and hormone receptor-positive, hormone therapy will likely be the first treatment you’ll receive.

Siteman advances in metastatic breast cancer treatment

Washington University experts at Siteman continue to pave the way for innovative breast cancer treatments through cutting-edge research. Some of our groundbreaking studies include:

Low-dose estrogen study – Research conducted at Washington University in 2009 revealed that raising estrogen levels may benefit women whose metastatic breast cancer no longer responds to standard anti-estrogen treatment. In 30% of study participants, their tumors either shrank or stopped growing.

Nanoparticles chemotherapy study – In 2018, our researchers discovered that when chemotherapy agents are exposed to radiation emitted by visible light, the drugs produce reactive particles that are toxic to cells. In contrast to traditional light therapy, this technique can target and attack cancer cells deep inside the body.

Breast cancer vaccine study – Washington University surgeon William Gillanders, MD, has led the development of personalized breast cancer vaccines. In this study, the research team took a small tissue sample from a patient’s tumor. Then, they used it to develop a personalized vaccine based on the tumor’s unique genetic information.

Our metastatic breast cancer specialists

The breast cancer specialist team at Siteman comprises outstanding Washington University medical oncologists, radiation oncologists, surgeons, radiologists, geneticists, psychologists and others. The diverse expertise of our specialists allows them to create individualized treatment plans for all metastatic breast cancer patients.

Success among Siteman metastatic breast cancer patients

Debbie Davis was only 34 when she was diagnosed with stage I breast cancer in 1993. She had no family history of cancer. While Debbie was terrified of her diagnosis and the uncertainty that came with it, she quickly transformed that fear into determination. She made the decision not to let her breast cancer stop her from living a fulfilling life. She maintained this mindset even after being diagnosed with metastatic breast cancer seven years later.

Throughout her decades-long cancer journey, Debbie has continuously received the most exceptional care and support from physicians at Siteman. Her treatment has included chemotherapy, radiation therapy and clinical trials. The expertise, dedication and compassion of Washington University breast cancer specialists at Siteman have allowed Debbie to take charge of her life and to be an incredible inspiration to other breast cancer patients.

Debbie’s cancer journey is just one of Siteman’s many breast cancer success stories.

Patient support

In addition to providing unmatched clinical care, Siteman provides compassionate support to help patients cope with the emotional and physical tolls of cancer treatment.

  • Nurses: specially trained to help patients cope with symptoms, treatment and side effects
  • Nurse navigators: clinically trained to provide guidance and answer questions at any point
  • Registered dietitians: provide guidance about nutrition and meals or snacks that will be good for you as you go through treatment
  • Psychologists: provide free mental health care for you and your family members
  • Palliative care specialists: provide support to help you manage pain and other side effects of your treatment

You’ve been diagnosed with metastatic breast cancer. Now what?

If you’ve been diagnosed with metastatic breast cancer, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychology services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms that may indicate your breast cancer has spread, or if you have received a stage IV breast cancer diagnosis and would like a second opinion from a breast cancer specialist at Siteman, please call 800-600-3606.

For Your Health: COVID-19 vaccination benefits children, families

For Your Health Graphic 2020



It may be hard to believe that, after almost two years, COVID-19 is still a major issue in the U.S. and the world over. It continues to affect our health and health care and to disrupt our daily lives. And the emergence of new variants, like omicron, can add even more uncertainty about when we’ll be able to return to more normal routines.

Yet, it’s important to remember that we’ve made a lot of progress over the past two years, even if it may not always feel that way. And earlier this fall, we passed another key milestone in our efforts to combat the coronavirus.

Children as young as 5 years old can now get a COVID-19 vaccine. And that is fantastic news.

Colditz

“Vaccination is one of the best tools we have for keeping kids and families safe and healthy,” said Dr. Rachel Orscheln, a pediatric infectious disease specialist at Washington University School of Medicine in St. Louis.

About 7 million children in the U.S. have tested positive for the novel coronavirus since the pandemic began, and even though serious cases are rare, they do happen. More than 8,000 children ages 5 to 11 in the U.S. have been hospitalized with COVID-19, and some children have died.

On top of reducing the chances that kids will get infected and become ill, vaccination helps prevent the spread of this infection to family members and caregivers, some of whom may be vulnerable to serious disease, Orscheln said.

Vaccination also helps keep kids in the classroom, by cutting down on infections in fellow students, teachers, staff members and others.

The vaccine prevents more than 90% of COVID-19 cases in children ages 5 and up. And as with vaccines for older teens and adults, the most common side effects are usually mild, including arm pain from the injection, fatigue, headache, chills and fever. These happen more often after the second shot and generally last just a day or two.

Some rare, more serious side effects are possible, and the safety of the vaccine in children continues to be monitored. But the current evidence shows it is overall safe and effective.

And not vaccinating children also has risks by increasing their chances of getting infected and becoming ill – something parents should consider when weighing decisions about vaccination, Orscheln continued: “By any measure available, the risk of developing infection with the novel coronavirus substantially outweighs any risk that may be associated with vaccination.”

Pediatricians, primary care doctors and other trusted health-care providers are great resources for parents looking to get more information about the COVID-19 vaccine for children. And children can get vaccinated in many different locations, from doctor’s offices to pharmacies to county health departments.

By mid-November in the U.S., about 10% of 5- to 11-year-olds received a first dose of the COVID-19 vaccine. As the number of vaccinated children increases, adding to the overall vaccination tally, we increase our chances of further limiting the spread of the virus. And that can be particularly important this time of year, as we gather with family and friends for the holidays and generally take part in more indoor activities where the risk of infection is higher.

Many children want to do their part to stop the spread of the coronavirus, protecting their families and getting back to more normal school and activity schedules, Orscheln concluded. “Vaccination is a critical strategy for accomplishing these important goals,” she said.

And those would be welcome gifts as we head into winter and a new year.

It’s your health – and your family’s health. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool, YourDiseaseRisk.com.

For Your Health: It’s a great time to be a quitter and get tobacco-free

For Your Health Graphic 2020



Though it doesn’t often make headlines these days, it’s hard to overstate how important quitting smoking is to health – and in ways many people may not be aware of.

Smoking impacts almost every organ in the body to some degree. It’s the main cause of lung cancer, of course, but it also causes 14 other cancers, including breast, colon, cervical and kidney cancers. It also greatly increases the risk of heart disease, stroke, emphysema and chronic bronchitis.

Colditz

Overall, smokers die a decade or more earlier than those who’ve never smoked.

Smoking also raises the risk of conditions that may seem less serious but that can have a major influence on quality of life and daily living. This includes rheumatoid arthritis, cataracts and macular degeneration, which is a common cause of severe vision loss in people over 50. If that’s not enough, smoking is also linked to tooth loss, slower healing of cuts, trouble getting pregnant and erectile dysfunction.

The good news is, quitting smoking lowers the risk of nearly all of these diseases and conditions – and over time, the risk of some drop to near that of a person who’s never smoked.

But you don’t need to wait years to see benefits. Minutes after your last cigarette, your heart rate drops.


Then, in the next several days, carbon monoxide levels in your blood fall to that of nonsmokers. And within months, coughing and shortness of breath improve.

While finding reasons to quit isn’t hard, actually doing it can be, as many smokers who’ve tried to quit know. The nicotine in tobacco is addictive, and that makes smoking different than many other behaviors we may try to change.

At the same time, quitting is far from impossible. Thousands of smokers stop for good every day. And getting help quitting can double, and maybe even triple, the chances of success.

But only a minority of smokers actually take full advantage of approaches we know help with quitting.

For most smokers, this means talking to a health-care professional about a combination of medication approved by the Food and Drug Administration (FDA) and behavioral support. Medications can include nicotine replacement therapy, like patches or gum, or other drugs, like bupropion. Among its other benefits, behavioral support can help smokers learn to work through barriers to staying smoke-free, like cravings and triggers that can lead to urges to smoke. Support can come in many different forms, including in-person or virtual classes as well as text-messaging and other programs.

If you’re a smoker who wants to quit, you’re in good company. Nearly 70% of smokers feel the same way, and more than half have tried to quit in the past year.

So, if you’re ready to quit – or even ready to just start thinking about quitting – November can be a great month to do it. The American Cancer Society’s Great American Smokeout is Nov. 18. The annual event gives smokers a target date to quit, while highlighting resources for becoming and staying tobacco-free.

Why not celebrate these last couple months of the year by doing something really wonderful for your health? Yes, quitting is hard. But you can do it.

It’s your health. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of the free prevention tool YourDiseaseRisk.com.

For Your Health: Seeing pink is a great mammogram reminder

For Your Health Graphic 2020



If the pink popping up in store displays and across our screens hasn’t given it away already, October is Breast Cancer Awareness Month. And while it focuses on a serious disease, I always appreciate the opportunity it gives my colleagues and me to highlight ways women can look after their breast health.

One of the most important things on that list: getting regular screening mammograms.

It’s a message many women are used to hearing, but coming up on two years into the COVID-19 pandemic, it’s also a message that’s more important than ever.

Dr. Graham Colditz

Mammograms are a type of X-ray that help find breast cancer in earlier stages when it’s easier to treat. With disruptions in health care and concerns about safety, especially in the pandemic’s early months, many women missed their scheduled mammograms. And some have yet to get caught up.

But we know that keeping up with regular health care remains extremely important even during a pandemic, and most hospitals and screening facilities are back to their regular schedules and are taking steps to keep patients safe.

“If a woman is overdue for her mammogram, she should come in as soon as possible,” said Dr. Debbie Bennett, chief of breast imaging at Washington University School of Medicine in St. Louis. “Delays in screening can lead to delays in breast cancer diagnosis.”

For the best chance of catching cancer early, most women should get a yearly mammogram starting at age 40.

Women who are at increased risk of breast cancer, because of factors like family history or medical history, may need to start screening earlier. And it’s best to talk with a doctor about your breast cancer risk sometime in your 20s.

“Many of the strategies to prevent breast cancer, or catch it in its earlier stages, begin at a younger age for women who are at higher risk,” Bennett said. “That’s why it’s important that women find out by age 30 whether they would benefit from screening or other tests in their 30s.”

This can be particularly important for Black women, who are impacted unequally by breast cancer. Not only are Black women 40% more likely than white women to die of breast cancer, they also have the highest rate of developing the disease before age 40. Earlier screening, and other important care, in women at higher risk could help narrow such gaps.

To schedule a mammogram or get more information about screening, call your primary care provider, local hospital or screening facility. Some hospitals even offer mobile screening clinics, often called “mammography vans,” which can set up in neighborhoods near you.

Most insurance plans cover mammograms, and many facilities take part in programs that can help provide free or low-cost tests for those who need it.

With the pandemic ongoing, it’s important that women take time to look after their health, even as they have more on their plates than ever, Bennett said. And getting mammograms is a relatively quick and easy way of doing that.

“Screening mammograms are an important part of self-care,” she said. “We want to give all women the best chance of living long, healthy lives.”

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of YourDiseaseRisk.com, a free, personalized tool for helping people reduce the risk of cancer and other chronic diseases. An epidemiologist and public health expert, he has a long-standing interest in the preventable causes of disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

To schedule a mammogram, breast imaging appointment, or to learn more about our breast health services, or complete this form.

Appointments are available at:

For Your Health: Even a little exercise helps

For Your Health Graphic 2020



Here’s a secret about physical activity that you should know and share: Even a small amount can give your health a boost.

Dr. Graham Colditz

And that can be really important, maybe even inspiring, to hear. Especially these days. Studies have found that many people have reduced their physical activity during the pandemic. It’s easy to see why, with stay-at-home orders, safety restrictions at gyms and recreation centers, and the general upending of everyday life, including how we work, pick up kids from school and run errands.

While there’s evidence we’re returning to more regular amounts of activity, the delta variant and halting rates of vaccination mean our daily lives are likely to be disrupted to a degree for some time.

But one thing we know about physical activity and health – whether it’s during a pandemic or not – is that we don’t need to get high levels of activity to start seeing benefits. Any movement you can add to your day or week is worth doing. And some of the biggest health gains can come when going from getting little or no regular activity to some activity.

So, take the pressure off yourself. You don’t need to wait to be inspired to train for a marathon, or until your schedule lets you fit in 10,000 steps a day, or until the pandemic is over. Just do whatever you can right now. And with cooler September temperatures and fall work and school schedules kicking into gear, it’s a great time to try fun and creative ways to add extra movement to your days.

Here are five ideas to get you started:

  • Park at the far end of the lot to get extra steps to the store
  • Set a timer to remind yourself to stand up and take a brief walk every hour, even if it’s just around your desk or living room
  • Stream a five-minute video about stretching or any other light activity you might want to try, like chair yoga or tai chi
  • Walk with your kids to the bus stop or from the parking lot to the school
  • Take the stairs next time you need to go up or down a floor or two

Simple efforts like these can naturally build on each other and just become part of your routine. They don’t cost a thing, and the more activity you get, the more benefits you receive.

Current guidelines set a higher goal of 2½ hours or more of moderate physical activity each week because studies have found, at these levels, we see most of the health benefits. This regular activity can lower the risk of heart disease, stroke, diabetes and cancer, and can boost our energy level, mood and overall quality of life today and in the future.

While that amount of activity is always a great goal, adding small amounts of movement to our days is a great place to start and worthwhile on its own. To quote from a campaign promoting the latest “Physical Activity Guidelines for Americans”:

“Do what you can. Even five minutes of physical activity has real health benefits.”

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention and the creator of YourDiseaseRisk.com, a free, personalized tool for helping people reduce the risk of cancer and other chronic diseases.

An epidemiologist and public health expert, he has a long-standing interest in the preventable causes of disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

For Your Health: Young adults, keep eating your vegetables (and other great advice)

For Your Health Graphic 2020



If you’ve finally reached that age when you’re officially an adult and starting to branch out on your own for work, school or another adventure, you’ve likely received a lot of advice from the older adults in your life. Some of it you may have sought out. Most of it, probably not.

And, yes, as you’ve guessed, I’m here to add to that latter list with some tips about a topic that may not be very exciting but is actually quite important: your health.

Dr. Graham Colditz

Admittedly, it may feel a little odd to get advice about health at an age when you, and most of your friends, are probably pretty healthy. But what you do today really does matter, not only in helping to improve how you feel right now but also in laying the foundation for lifelong wellness, so you’re less likely to develop serious diseases like stroke, diabetes and cancer down the road. Start with these tips:

Eat a mostly plant-based diet, and be physically active. A healthy diet and regular exercise are cornerstones of good health. On their own, they lower the risk of many diseases, and they can help keep weight gain in check. Try to build up to at least 30 minutes of activity each day. When it comes to eating, focus on fruits, vegetables, whole grains and beans – and try to cut back on red and processed meats, sugary drinks and fast foods.

Get enough sleep. It’s easy to skimp on sleep, especially when trying to catch up on things you missed during the pandemic shutdowns. But for your mental health and overall well-being, it’s important to make sleep a priority and to try to get 7 to 9 hours a night.

Keep a lid on alcohol. The more we know about alcohol and its many risks, the more we know that not drinking is the healthiest choice overall for people of all ages. If you do drink, try to keep it to a minimum – and be in control.

Keep up with health care and vaccines, including those for HPV and COVID-19. As an adult, you’re now in charge of your health care, and that can be a big change from when you were younger. Be sure to see a doctor for any regular care you may need or if you have any health concerns. And stay up to date on adult vaccines. If you haven’t had them already, this includes the HPV vaccine, which helps prevent multiple cancers, and the COVID-19 vaccine, which is increasingly important to protect against very infectious variants, like Delta.

Stay smoke-free, or get smoke-free. No surprise here. Staying – or getting – smoke-free is one of the best things you can do for your health. So, if you don’t smoke, keep it up. And if you do smoke, try to quit as soon as possible. Smokefree.gov is a great place to get free help, and it has tools for teens, vets, women and Spanish speakers.

Mind your mental health. In regular times, many young adults struggle with depression, anxiety and related conditions. And with the pandemic, rates have become more pronounced. If you have concerns about how you’re feeling, reach out to a health professional. Don’t be shy. You’re not alone, and treatment can help you feel better.

Taking time to look after yourself and your well-being is one of the best gifts you can give yourself as an adult. And it can never start too early. You deserve it.

It’s your health. Take control.

For more tips, see Early Adults’ 8ight Ways to Better Health and Lower Risk of Cancer.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

What is the most common type of skin cancer? What you need to know and what to look out for

Basal cell carcinoma (BCC), the most common type of skin cancer and the most common type of cancer in humans, accounts for about 8 out of 10 skin cancers. Basal cell carcinomas usually develop in skin that has been exposed to sunlight. These cancers grow slowly, meaning that most are curable and cause minimal damage when caught and treated early.

What is basal cell carcinoma?

Basal cells are one of the three main types of cells in the top layer of the skin. When DNA is damaged due to exposure to ultraviolet (UV) radiation from the sun or tanning beds, changes occur in the basal cells in the outermost layer of the skin, resulting in uncontrolled growth. This is when BCC most often occurs. However, it may also result from exposure to ionizing radiation and/or arsenic.

If you have fears concerning BCC and its potential consequences, you’re not alone

Finding out that you have BCC, or worrying that you might have it based on family history or changes in your skin, is a very scary experience and gives way to many types of fear: fear of the unknown, fear of needles, fear of mortality, fear of the future. Know that no matter the fear you may be feeling, Siteman will be there to support you throughout your skin cancer journey. It’s also important to remember that while receiving a diagnosis of BCC can certainly be frightening, it is rarely fatal. Still, if left untreated, it can become locally destructive.

BCC symptoms and skin changes to look out for

Keeping an eye on your skin is crucial to ensuring that you are able to identify abnormalities should they arise. Check for BCC where your skin is most exposed to the sun, such as the face, ears, neck, scalp, chest, shoulders and back (though this cancer can occur anywhere on the body). Five warning signs of BCC are:

  • Lumps or skin nodules that appear shiny or that have visible blood vessels. The lumps may grow over time
  • Areas on the skin that look like scars
  • Itchy patches of skin
  • Red or patchy areas of skin that resemble eczema
  • Sores that have a depression in the middle, look crusty or bleed often

Hereditary predisposition, skin color and increased risk for BCC

There are several genes and hereditary syndromes that are linked to the development of skin cancer. Basal cell nevus syndrome (also known as BCNS, Gorlin syndrome, Gorlin-Goltz syndrome or nevoid BCC syndrome), Bazex-Dupré-Christol syndrome (BDCS), Rombo syndrome and xeroderma pigmentosum are rare inherited skin disorders that can lead to basal cell carcinoma.

People with fair skin, blond or red hair, blue, green or grey eyes, or skin that burns easily are at highest risk of developing BCC. However, all people with a history of sun exposure or indoor tanning are at some level of risk, so ensuring that you are protected any time you’re exposed to UV radiation is critical.

BCC screening, diagnosis and beyond

Regular screening for basal cell carcinoma is not usually recommended, but if you find something on your skin that concerns you, you should make an appointment with your provider right away. During a skin exam, your provider will look for any growths, spots, moles or bumps that might be cancerous or precancerous. If something abnormal is found, your provider may do a biopsy, which will reveal whether you have skin cancer and, if so, what type. Being proactive about examining your skin and getting anything abnormal checked promptly means greatly reducing your risk of developing BCC.

BCC can almost always be cured when caught and treated early. While this type of cancer rarely spreads beyond the original tumor site, the lesions can become dangerous and grow deep into the skin, invading soft tissues, bones or nerves when left untreated. It is very rare that a BCC spreads to lymph nodes or metastasizes, and it almost never endangers life.

The Siteman approach

As a leader in cancer treatment, research, prevention, education and community outreach, Siteman has the expertise, experience and compassion to carry you through your cancer journey. With a multidisciplinary approach, a full team of specialists meets each week to discuss all cases, reviewing each one and determining the best treatment plan for each patient.

Many people diagnosed with skin cancer are concerned about what will happen to their appearance as a result of their cancer, particularly if tumors are on the face. Siteman is a leader in Mohs micrographic surgery, a procedure that minimizes damage to healthy tissue and leaves the smallest possible scar.

BCC treatment options

At Siteman, skin cancer patients receive treatment from multidisciplinary teams made up of dermatologists, dermatologic surgeons, medical and surgical oncologists, radiologists, radiation oncologists, ophthalmologists, otolaryngologists and plastic surgeons. Our physicians meet regularly to coordinate and discuss treatment options, putting together personalized treatment plans for each and every patient. No two cancers are the same; no two treatment plans should be, either.

Siteman currently offers the following treatment options for BCC:

Excision/Mohs micrographic surgery: excision involves the removal of a skin cancer along with some healthy tissue around it. Mohs micrographic surgery involves removing individual layers of cancer tissue in stages, allowing for the removal of the greatest number of cancer cells. Mohs has the highest cure rate of any BCC treatment.

Radiation therapy: low-energy X-ray beams are used to destroy the tumor, with no need for excision or anesthesia. It may take several treatments over the course of a few weeks, or daily treatments for a specified amount of time, to fully destroy the tumor.

Vaccines/immunotherapy: HPV is strongly linked with BCC and other non-melanoma skin cancers. The 9-valent HPV vaccine has been proven not only to prevent BCC from forming in the first place, but also to effectively treat BCC when injected directly into tumors. Immunotherapy involves the use of medicines to stimulate a person’s immune system to identify and destroy cancer cells.

Topical chemotherapy: this type of chemotherapy is put directly on the skin (usually in the form of a cream or ointment), rather than being given by mouth or injected into a vein. Since the drug is only applied to the skin and doesn’t spread to other areas of the body, it doesn’t cause the same side effects as systemic chemotherapy. Because topical chemotherapy can’t reach deep cancer cells or those that have spread to other organs, it is only ideal for those with superficial BCCs.

Surgery: in addition to excision and Mohs surgery, there are other surgical treatment options for BCC. Curettage and electrodesiccation is a treatment in which a spoon-shaped tool (curette) is used to scrape cancerous skin tissue, followed by the application of an electric current with a thin metal instrument or needle to destroy any remaining cancer cells. Additionally, laser ablation involves directing a carbon dioxide laser at the tumor(s) and can be used to treat superficial BCCs.

Our care team

The skin cancer treatment team at Siteman is comprised of a wide range of specialists, including medical oncologists, radiation oncologists, surgeons, dermatologists and psychologists. The diverse expertise of our collaborative team is what allows our specialists to create personalized and compassionate treatment plans for each and every patient.

The importance of getting screened

The American Cancer Society (ACS) recommends a cancer-related checkup, including skin examination, every three years for people aged 20-40. It also recommends that patients perform a skin self-examination monthly. By remaining proactive about wearing sunscreen when exposed to UV radiation, regularly monitoring your skin and seeing your provider when something looks concerning, you can greatly reduce or even eliminate your risk of developing BCC and other skin cancers.

You’ve been diagnosed with BCC. Now what?

If you’ve been diagnosed with BCC, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychological services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

To schedule a skin cancer screening, please contact the Washington University Division of Dermatology. The division is made up of a team of dedicated doctors who are skilled at detecting and treating basal cell carcinoma as well as many other skin cancers. If you have found something concerning on your skin, or if you simply want to come in for a routine checkup, please call them at314-362-8180. If cancer cells have already been detected during your screening exam and you wish to schedule a follow-up appointment with a skin cancer specialist at Siteman, please call 800-600-3606.

For Your Health: Make a health goal as relaxed as summer – one small change

For Your Health Graphic 2020



In our social media-driven world, it’s the big stories and the spectacular images that can often grab the most attention. And it’s not just in topics like news, politics or sports, but also in areas that are more personal, like health and wellness. Spend just a few minutes scrolling through our phones, and we may see popular posts about 1,000-mile bike rides, jaw-dropping yoga poses and eight-course vegan gourmet meals.

While such stories can certainly be inspiring, they also need to be kept in perspective. Because, really, when it comes to our health, it’s not big changes and one-time efforts that are often most important, it’s the day-to-day, steady steps we take over time.

Dr. Graham Colditz

And that’s great news for those of us who juggle work, school, kids, pets and any number of other commitments. There’s real power and real health benefits in making small, achievable changes to our behaviors. Such changes are easier to get started and easier to keep up than large, daunting challenges. And that also makes them more likely to become ingrained, healthy habits that we can then further build upon in the future.

So, as we settle into these long, and hopefully enjoyable, mid-summer days, it can be a naturally good time to pick one relaxed health goal to work on through the rest of the season. And it can be anything, really. Just try to be specific about what you want to accomplish, and make it something you feel you can keep up over time.

“One of the most common pitfalls in setting goals is making them too broad or unrealistic,” says Liz Salerno, a biobehavioral scientist at Washington University School of Medicine in St. Louis. “I don’t pressure myself to go from being inactive to running a marathon in two months!”

While keeping your goal focused, you can also be as creative as you want. There are many different paths to improving health and well-being. Start by thinking about something general you may want to work on – like your food choices, how active you are or how you deal with stress – then pick one small goal that can help you get there. And don’t be afraid to keep it fun. It’s summertime after all, and we’re coming out of a long and stressful pandemic.

Some ideas to get started:

  • Tend a plot in a public garden two days a week
  • Roller skate or ride bikes with friends once a week
  • Take a dance class two days a week
  • Take a meditation or stretching class two days a week
  • Volunteer to help maintain local parks and paths once a week
  • Drink one fewer sugary drink each week
  • Eat an extra piece of in-season fruit two days a week
  • Grill veggie or meat-alternative burgers rather than hamburgers at summer barbeques
  • Make appointments for you, or your kids, to get caught up on doctor visits and vaccinations (not fun, but very important)



Try to keep your goal up through summer. If you get off course, don’t worry. Just try to get back on track, and if you need to, modify your goal. Likewise, if you need to add a little extra to a goal to keep up your motivation, that’s great, too.

Adjusting along the way can be key to being successful with a new behavior, says Salerno. “Our progress towards a goal is almost never linear, so we have to be patient with ourselves as we work toward it.”

The relaxed energy of summertime offers a great opportunity to make some low-stress strides toward improving our health. And even though they may not trend on social media, they can still have important benefits.

“Oftentimes the small baby steps we make don’t feel groundbreaking,” says Salerno. “But they are.”

It’s your health. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.