Society Joins Brazil NGO and Carolina Herrera for Breast Cancer Awareness

From left to right: Andrea Natal, a breast cancer survivor; Carolina Herrera, fashion designer; Dr. Maria Caleffi, FEMAMA; and Alessandra Durstine, vice president of regional programs at the American Cancer Society, at the launch of the "Pink October" event in Rio de Janeiro, Brazil.

On Tuesday, October 5, the American Cancer Society joined our collaborating partners, the Brazilian breast cancer coalition (FEMAMA), to launch their "Pink October" event to raise breast cancer awareness in Rio de Janeiro, Brazil. The theme of the event was "without investment, breast cancer has no cure." To celebrate the launch, fashion designer Carolina Herrera dedicated profits from her perfume 212 for breast cancer programs in Brazil. Alessandra Durstine, vice president of regional programs for the Society’s global health department, joined Herrera and Dr. Maria Caleffi of FEMAMA to speak at the event, which attracted more than 50 journalists. Following the launch, survivors from Brazil participated in a parade outside of Renner department store in Rio de Janeiro. During the evening, the Society joined FEMAMA and Brazil's minister of health to light Brazil’s famous Cristo Redentor statue in pink.

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[Yogendra]

A.The speaker of the PSA is the National Responsible Fatherhood Clearinghouse. They are goervnment sponsored and we can assume that they are speaking from a professional perspective. B.The occasion for this PSA is to tackle and issue that has increasingly detrimental in the life of Americans. Studies are showing that the lack of a father figure in a household correlates with teen pregnancy, truancy, drug and alcohol abuse, and educational and emotional problems. The issue is urgent because as lack of father involvement decreases; the violent activity in teens and those who grew up without their fathers being involved will increase. C.The purpose of this PSA is to increase father involvement in the life of children. The National Responsible Fatherhood Clearinghouse is hoping that fathers will become more active members in both their households and the lives of their children.D.The target audience of this video is the fathers of America. At a more in-depth look we can claim that the target audience is African-American fathers with daughters. The attitude I this message is very gentle yet it gets the point across. According to the YouTube statistics, the video was most popular among males and females in America between the ages of 45-54.E.The PSA would not apply to anyone who was not a father. This excludes younger Americans and women as well. Adolescent Americans who are too young to have children, don’t have children, and have their fathers involved in their lives would have trouble understanding the message. They would not be able to grasp the concept of being a father or how life is growing up without some sort of father figure in their lives.F.The PSA begins with an elderly African-American woman knitting what appears to be a pillow. She overhears noise from outside of her window and when she goes to check she sees a middle-aged Black man doing what appears to be cheerleading. The clip shows the black man performing the cheer alone before they show that a little girl dressed in cheering attire is behind him. The narrator cuts in as they begin to perform the cheer in unison. Once the narrator is completed, the screen cuts to black. G.I believe that this PSA is effective because it has the perfect combination of humor, light-heartedness, and seriousness as well. The PSA tackles a serious issue in a gentle way getting both their point across while making it entertaining for the viewer at the same time. It also makes it seem that father involvement is fun and entertaining which will connect with its viewers.

[Idayanti]

I am just going to add to Aggiewho's response. The fheturr testing as Aggie said would be a biopsy. That is typically done in the urologists office and takes approximately 30 minutes to an hour. It is slightly uncomfortable for the patient but not horrible. Depending on those results(will take 3-5 days to come back from the lab), then your Dad's physician will give him different treatment options (if it would be cancer-which remember it could just be an infection).My only suggestion is for someone to go with your Dad to his next appointment. Write down questions never be afraid to do this. There are no such thing as dumb questions, doctors sometime assume that you understand everything when you don't ask.

[Hiba]

Let me take this opportunity to ropesnd to some of the comments.One participant suggests referring patients for urologic evaluation when the PSA has doubled – this is an arbitrary cut-off that will miss many cancers and is not backed by data. If a change over time is going to be used, and increase of 0.35 in one year if the PSA is less than 4 or 0.75 if the PSA is greater than 4 has some validity.Dr Zapf-Gilje points out the disparity between what I have suggested in the original contribution and what was reported in the media with regards to the large screening studies. This was indeed noted by many urologists and is not easy to explain. The American study was negative, and this seems to have been the focus of the headlines. They also chose to interview some prominent critics of PSA screening but no proponents. In my opinion the media reports were not balanced.Dr Potter-Cogan asks for more concrete recommendations for screening. The core recommendation is to screen every man over the age of 50 with more than 10 years life expectancy. In my own practice I recommend an initial PSA at 40 or soon thereafter. If it is less than the age-appropriate median 0f 0.7, I check again in 5 years. If greater, I check annually. This goes along with the NCCN guidelines and is based on the fact that the risk for subsequent diagnosis of prostate cancer is greatly increased in men with a PSA greater than the age-appropriate median. In addition, men with a family history (father/brother/paternal uncle) and black men are offered screening starting at age 40. One aspect that is likely to change in the future is the frequency of screening – annual screening is likely overkill and every 2nd or 3rd year is probably adequate. In the European study, screening was every 4th year. Currently, however, the recommendation is for annual screening. I always do a DRE at the same time. There are clearly cancers that are palpable despite a normal PSA. The DRE is also easy to do and free – although uncomfortable for patients.A couple of participants comment on the continued confusion in this field. We do not have all the answers – and there are prominent voices that still go against screening. The take home message should be that there is evidence that supports screening and its ability to save lives – and the emerging evidence with longer follow-up is that this can be done with acceptable “collateral damage” (measured as the number needed to screen and the number needed to treat to save one life). What remains is further fine-tuning of what we do. The 85 year old patient should not be part of the discussion – he does not need screening. The 75 year old is much more difficult. Furthermore, whether screening is of any benefit for the most aggressive cancers remains to be shown – likely most benefit is with the intermediate risk patients. There is a long list of treatments for aggressive prostate cancer that prolongs survival and two recent publications highlight the remarkably good survival in men with high risk non-metastatic disease – but the question remains whether detecting them earlier makes a difference. The true problem is with the low risk patients, who do not need treatment of any kind. One of the most important unresolved questions in prostate cancer research is which patients are suitable for active surveillance.I would say that we all are very bonded to our patients – not just GPs and not just in small towns. Every screening test, every biopsy and every treatment must be weighed very carefully. “Missing” a prostate cancer due to lack of screening is troublesome – yet there has been no evidence until recently that detecting that cancer any sooner with screening would have made a difference. This is incomprehensible to patients ultimately diagnosed with prostate cancer, who tend to be the biggest proponents of the test, yet most of the non-urologic medical community questions its value. We have to be careful with emotional arguments regarding individuals. What if the family friend or the patient we pass in the street had a small volume Gleason 6 prostate cancer and is now incontinent and impotent after radical prostatectomy? He still believes PSA saved his life, but we know better.The age issue touched upon by Dr Aller is not straightforward. The risk of having cancer and the risk of having a more aggressive cancer increase with age – this is part of the reason why it is difficult to determine an age above which screening should be discontinued. This is also why age-dependent PSA cut-offs are mostly not used, since they will lead to more missed cancers in the older men. The one thing that clearly changes with age is the likelihood of dying from something other than prostate cancer, and this plays heavily into treatment decisions (especially regarding active surveillance). Unfortunately it is difficult to predict this risk in an individual patient.

[Osvaldo]

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