At the age of 30, when Tracie Metzger found a lump during a self-breast exam, she didn't think much of it. After all, she had already had fibroadenoma, a common benign tumor, three years before. She decided to have it removed.

"I woke up in the recovery room to my breast surgeon holding my hand and telling me it was breast cancer," Metzger recalls. "Obviously, the world turned upside down."

Breast cancer in younger women, those under 40, is typically more aggressive. Metzger decided to be aggressive right back. If the cancer did come back, she didn't want to regret not going to any length.

"I did six months of chemotherapy ... lost all my hair to that whole deal. Decided to have a double mastectomy with reconstruction, mostly due to the fact that I found another (benign) lump in the midst of my treatment," she says.

Last year, she celebrated 10 years cancer free.

Beyond Awareness

When she was diagnosed, Metzger was a mother of two very young children. She didn't know a single person under 50 who had experienced what she was going through. With her friend Dawn Harvey, Metzger founded Pink Ribbon Girls to offer education, awareness and social support to younger women battling breast cancer.

With more than 5,000 members across the nation, half of which are in Greater Cincinnati, Pink Ribbon Girls celebrates its 10th anniversary this October during breast cancer awareness month.

This year, the battle against breast cancer has grown to encompass more than awareness, focusing on survivorship and finding a cure.

"We really need to move beyond awareness and put our energy and resources "¢ toward focusing on how we can prevent breast cancer," says Ann Hernick, president of the Breast Cancer Alliance of Greater Cincinnati (BCA), a member of the National Breast Cancer Coalition advocacy network.

The Breast Cancer Deadline 2020 initiative from the national coalition calls for scientists and leaders to eradicate the disease in less than nine years. The three-pronged approach includes developing a vaccine for breast cancer similar to that developed for cervical cancer, preventing the disease from metastasizing and establishing measures for primary prevention of the disease.

Primary Prevention

"We have spent a lot of money and many years of time, and we still don't know what are the causes of breast cancer. It's really going to take a movement to do it," Hernick says.

Primary prevention includes screenings such as mammograms and self-exams, but might also include avoiding alcohol, maintaining a healthy diet and weight, and forgoing hormone replacement therapy during menopause.

"The most important factors are quitting smoking and diet and exercise," says Dr. Jennifer Manders, surgical oncologist at The Christ Hospital.

For high-risk women who have a genetic predisposition to develop breast cancer, drugs such as tamoxifen can be used to reduce risk. Some women even choose to have preventative double mastectomies and breast reconstruction.

"Because so many more women are surviving, we're really focused on survivorship and dealing with the side effects and consequences of therapy throughout a woman's life after treatment," Dr. Manders says.

The negative side effects of breast cancer are physical, such as bone mineral density loss and menopausal side effects, as well as psychological.

Not One Cancer

The Christ Hospital takes a multidisciplinary approach to recovery, offering ongoing support groups, counseling for patients and their families, physical and occupational therapy, even Tai Chi and Pilates programs.

"We're a living example that you can beat breast cancer and go on to lead a relatively normal life. You can grow and live and thrive beyond breast cancer," Metzger says.

But not everyone survives.

"I think most Americans have a very complacent view about breast cancer. They feel that we must be winning the war because everything is very pink and very pretty, and if you get a mammogram, you'll be fine," Hernick says. "But in reality, we're losing 40,000 lives a year to the disease, and that's unacceptable."

Breast cancer incidence rates in Ohio and Kentucky are consistent with national levels, but Ohio ranks fourth in mortality rates, with 1,730 estimated deaths per year, according to Hernick.

Nationally, breast cancer-related deaths have been decreasing since 1975. This is largely due to better treatment options and early detection, according the American Cancer Society's 2009-2010 Breast Cancer Facts & Figures report.

"We have learned this: Breast cancer is not one disease," says Hernick. "Breast cancer is many diseases, and it's complicated and is treated in a variety of different ways. You have to be sure that the treatment your doctor recommends is the right treatment for your type of breast cancer."

There are different classifications of breast cancer based on whether the tumor is invasive or noninvasive, on the location of the tumor inside the breast, and on the type of hormone receptors present in the cancer cells.

Because breast cancer can be so complex, the American Cancer Society recommends getting a second opinion, or even a third, before moving forward with a treatment program.

According to Manders, the new focus is on developing better chemotherapy and biological therapy agents for aggressive forms of breast cancer, which would include Tracie Metzger's triple negative tumor.

"(Triple negative) is very rare, and it's challenging. After your treatments, it's kind of a wing and a prayer," Metzger says.

Better Treatments

Only about five percent of diagnosed breast cancers are triple negative. Triple negative tumors lack estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2 (HER2), meaning that they don't respond to some breast cancer treatments.

"There are many types of tumors that seem to be resistant to the effects of chemo and persist or progress during chemotherapy," Dr. Manders says.

Early diagnosis can reduce mortality, and magnetic resonance imaging (MRI) is especially useful in screening high-risk women. New imaging technologies, such as a whole breast ultrasound and digital tomosynthesis, which creates a three-dimensional image, are being examined.

"Tomosynthesis is similar to a CT scan where image slices of the breast at different steps are taken, so the resolution is higher and the sensitivity of picking up the tiniest lesions is higher," Dr. Manders says.

At The Christ Hospital, scientists are studying radiofrequency ablation (RFA), which delivers an electric current to the tissue, to treat the margins around a tumor after a lumpectomy. "(RFA) is new and innovative to help prevent cancer recurrence locally," she says.

Keep the Hope

Despite new diagnosis and treatments, research will need to pick up the pace to meet the NBCC's 2020 deadline. But Hernick believes their ambitious goal is reachable.

"I was diagnosed when my daughter was 11, and I didn't want her to have to face what I went through. She's going to be 25 next month, and her generation is going to have to face breast cancer. It is a reality," Hernick says.

"I just want us to do better. I know we can do better. I believe we need to create a sense of urgency in moving us forward to eradicate this disease." 


Making Strides Against Breast Cancer Walk 2011

Celebrating less cancer and more birthdays "” it's a pretty simple concept that has turned into an annual nationwide event of survivorship and hope.

On Oct. 9, Greater Cincinnati will host its own Making Strides Against Breast Cancer walk in Yeatman's Cove Park, giving cancer survivors, along with their family and friends, the chance to honor survivors and loved ones lost. Cincy is among the media sponsors for the event.

According to the American Cancer Society, the walk shouldn't be viewed as a race, but rather, a chance for those fighting cancer to show their support in a celebratory event.

There is no registration fee and people of all ages are welcome to participate and help raise funds for cancer research. Registration begins at 8 a.m. and the walk begins at 9 a.m.

To donate to the American Cancer Society, log on to
http://makingstrides.acsevents.org/ and donate to a specific walker, team or event.

"” JULIANNA ROCHE



Health Profiles

Dr. David D. Aichholz, MD offers his patients personalized, compassionate care before, during and after pregnancy as well as lifelong comprehensive women's health care with individualized innovative therapy for each and every patient. Dr. Aichholz is happy to announce he is now providing in-office anesthesia for patient comfort during Adiana Tubal Sterilization procedures and NovaSure Endometrial Ablations. 4D ultrasounds (for any pregnant woman "” you do not have to be a patient of the practice), and urinary testing are both available in his office. He is proud to be a second generation OB/GYN with 17+ years of practice in the Cincinnati area. Dr. Aichholz has been the #1 top rated OB/GYN for the past three years as voted by the patients on www.Cincinnati.MD.com. He is a board certified physician.
4834 Socialville-Foster Rd., Suite 60 | Mason, OH 45040 | (513) 229-8010 | www.ikeobgyn.com



Mercy Health
Collectively, Mercy Health's six hospitals offer a complete array of the latest and most advanced women's health services available in Greater Cincinnati. In addition, they employ some of the region's most experienced and dedicated specialists committed to providing superior, compassionate clinical care.

Women's services include breast and bone care, such as digital mammography and bone density screening; cancer and surgical care, such as the blood and marrow transplant program and robotic assisted and minimally invasive surgery; and women's health education programs and support groups.

Mercy Health is a comprehensive healthcare network with care-delivery sites throughout Greater Cincinnati. Mercy encompasses six award-winning hospitals, eight senior living communities, primary care and specialty care physician practices, imaging/diagnostic centers, social service agencies, urgent care centers, health and wellness centers, weight loss management and a variety of outreach and ambulatory centers.

For more information, visit www.e-mercy.com.


The Barrett Cancer Center at University Hospital
Over the past 22 years, the Barrett Cancer Center at University Hospital has built a reputation based on excellence in cancer research, education and comprehensive patient care. The combination of compassionate and dedicated doctors, nurses and researchers, as well as access to the latest medical technology, has kept the center at the forefront of understanding, diagnosing, preventing and treating cancer for people all over the world. Through a collaborative relationship with Cincinnati Children's Hospital and Medical Center, the center also provides radiation therapy for pediatric patients.

As part of the University of Cincinnati Cancer Institute, the center is poised to become a major national resource in the fight to cure cancer. An upcoming expansion of the center will add five floors to the existing building and create more resources for patients. This project will allow space for a new bone marrow transplant program, a multi-disciplinary women's cancer program, as well as an innovative men's cancer initiative.

UC Health offers patients comprehensive, compassionate treatment, and the benefit of science-driven medicine combined with some of the most advanced imaging and treatment technology.

For more information, call (513) 584-3200 or visit www.uchealth.com/cancer.