As our world becomes increasingly faced paced, and distraction is a battle many of us face on a minute-by-minute basis, meditation is something that is being suggested time and time again to help ease this lack of focus. Meditation can at times feel like yet another chore on our very full to do lists. And although there are many resources out there, it can be difficult to know where to begin.
Starting with short, guided meditations can be just the ticket to feeling a sense of calm and relaxation. Unity has released these free, short 4-6 minute guided meditations on YouTube. These meditations are a wonderful resource when you feel like you could use a prayer, comforting words, or a moment of peace.
Feel like connecting with other meditators? Check out also the Tigerlily Pure Cat Initiative for a guided meditation with Natalie Lewis, every Tuesday at 5pm!
In my first article, I introduced the power of prayer, which included chanting on my own and relying on Silent Unity for prayer support. In this article, I will briefly share some approaches to prayer that work for me, and some benefits of praying for others individually and/or with others. Here is the main wisdom I learned about prayers over the course of my journey. Prayers are always heard and are always answered according to divine timing. According to spiritual author Doreen Virtue, “Everything operates according to the Universal Laws of Divine Timing. This means that certain pieces of the puzzle must first fall into place so that other parts can come to fruition. If you try to skip or rush certain pieces or parts, the whole plan will lack a solid foundation” (Virtue, 17). Essentially, the divine has its own sense of timing that does not always fit with our sense of time. This has been a tough lesson for me to learn over the years, as patience is not my strong suit; however, I respect divine timing, because I notice that when my prayers are answered, the timing always seems perfect. So instead of worrying about when a prayer will be answered, I focus more on praying sincerely and with gratitude for the higher power I am praying to, knowing that my prayer has been received and will get answered in its right time. I make sure to thank the higher power in advance for hearing and answering my prayer either mentally, verbally, or in my heart. This heart-centered way of praying is what has given me a deeper sense of a higher connection and patience, and has cultivated surrender within me. Surrendering demonstrates faith and confidence in the divine and ensures that I am out of the way to let the higher power go to work on my behalf. Note that this way of praying is effective when praying alone or with others.
I was accustomed to praying by myself, but the long and winding road of my life brought me to learning and experiencing the benefits of praying within a group.
After I moved back to Canada from the west coast and finished my degree in Therapeutic Recreation, I was confused about how to proceed on my life’s path. While I was figuring out what to do with my life, I discovered some online courses offered by Ananda Sangha, a spiritual organization founded by the disciples of Paramahansa Yogananda, the spiritual teacher who first brought Kriya Yoga to the west in the 1920s and wrote the book “An Autobiography of a Yogi.” Ananda Sangha deepened my knowledge of the benefits of meditation and healing prayers and reconnected me to my fulfillment of praying with a group. Yogananda taught that praying as a group for the same person, people, or situation amplifies the healing and accelerates the benevolent outcome of what you are praying for (Ananda Sangha Worldwide). He also said that the channel is blessed by what flows through it, so when we are praying for others, it brings blessings and healing to ourselves. Know that praying for yourself or even asking others to pray for you is still selfless, because the more you heal, the more you are helping others to heal, hence you are following the wisdom of the phrase “Healer, heal thyself!”
So dearest reader, if you would like extra prayer support for yourself or for someone else or you would just like a dose of high positive and powerful energy, we cordially invite you to join the Tigerlily Prayer Circle every month. And remember that you can always call the free 24/7 Unity Prayer line at 1-816-969-2000, or submit a prayer online at unity.org/prayer for additional support too where you can submit a prayer for yourself, or for others.
I remember the day I received the news I had been waiting 3 days for, from the time i had my first biopsy.
I noticed a lump under my armpit that had started to get larger. I had a mammogram in January of 2019 but it was not detected at that time. Although the lump was under my armpit, when I met with my breast specialist after my mammogram she advised me that my lymph nodes may just be swollen but was told to keep an eye out for it in case it got larger. I had taken my son to Barnes & Nobles to pick out some books for being promoted to the 2nd grade. When I saw the number come across the phone I sat down to hear the news on the other end of the line. On June 7, 2019 I was diagnosed with breast cancer at 37 years old. It was Stage 1B, Grade 3, and the tumor was 1.3cm. I was Triple Negative with Invasive Ductal Carcinoma. In addition I carry the BRCA1 gene mutation which increased my risk for breast cancer and ovarian cancer.
I wasn’t surprised when my breast specialist delivered the news as I already had a feeling it would be cancer. I gathered the information and we scheduled an appointment to go over the next steps. I don’t think it hit me until I called my twin sister next to deliver the news. It was then that I broke down and started crying. I was unsure of what to expect but I knew that I would have to have surgery and possibly chemotherapy. I couldn’t let my son see me like this so I quickly dried my tears and we finished up our visit at the bookstore and went home. No matter what, I knew that I would get through this journey by maintaining my faith and keeping a positive mindset through it all.
I respect the fact that a lot of people like to keep things private and don’t care to share when going through things such as this. By sharing my story I feel that I can be an inspiration or motivation to someone else battling this disease, but may be afraid to get it checked out.
It is extremely important to get mammograms and to do monthly self breast exams. If something doesn’t feel right, please go to the doctor or reach out to someone to seek advice. Early detection is so important. If you have a family history of breast cancer, schedule an appointment for a mammogram before the age of 40 and get the genetic BRCA testing done as well.
Through it all I have maintained a positive mindset, prayed a lot, and kept my faith in God. Never in a million years did I think I would have to battle breast cancer at the age of 37. This is not the end of the world for me and I will continue to live my life to the fullest, as I know that God is in control!
The Tigerlily Foundation and Guiding Researchers and Advocates for Scientific Partnerships (GRASP) October conversation was co-hosted by keynote speaker, Dr. Tisha M. Felder, a Research Assistant Professor at the College of Nursing and Core Faculty on Cancer Prevention and Control Program at the University of South Carolina, and our Black patient experts, Patricia Fox, Tonya Hicks, Aliya Whipple and Joy Jenrette. The panelists focused on what it means to have “Cancer While Black: How Trauma, Fear, Generational Pain & Mistrust Impact Breast Cancer.”
“Cancer while black” is a metaphor for what it means to live while Black in America carrying the historical trauma of systemic and structural racism across generations. Dr. Felder explained the historical trauma that has led to the modern day reckoning of historical and cultural racism in medicine and health care. She shared research studies that described the stark differences between how Black people feel about their reality compared to White perception of daily life as a Black-American. Almost 60% of Blacks feel they are treated less fairly while receiving medical health treatment compared to only 26% of White persons. Dr. Felder went on to share that in her life everything is filtered through race. She is seen first as Black then a scientist.
A striking statistic from Dr. Felder’s presentation was the notion that there wasn’t always a mortality gap between various racial groups of women with breast cancer. The increased mortality rate for Black women occurred while there were numerous advances in breast cancer treatment in the 1980s. Why would the mortality rate increase with medical advances? Black women were and have not received the same care as their White counterparts. The unequal treatment has led to the loss of countless lives. This naturally flowed into the historical generational pain and trauma of oppression. Within the human body, this trauma and pain is stored as allostatic loads (AL). AL is the physiologic burden of chronic stress that can negatively impact health at the cellular or biological levels. Higher levels of AL have been associated with increased risk of cancer specific mortality among Blacks and Whites.
Another topic which resonated with audience members was the “Superwoman Schema”. The strong Black Woman role and its impact on personal stress levels. Dr. Felder urged the medical community to stop asking why Black patients should trust medical/healthcare but why do Black patient’s mistrust medical/healthcare.
Patricia Fox, author of “Declarations Statements of Healing For Women Braving Dis-ease and Tigerlily Angel Recruiter and Outreach Manager, stressed it is important to have no biases for age and race. There is a pathology of not just DNA but a pathology of generational experience that must be explored.
Tonya Hicks, business owner and Angel Advocate, advised patients to know your family history and get genetic testing.
Aliya Whipple, experienced computer operator, Triple-Negative Breast Cancer and BRCA2+ Thriver, recommended personalized care that takes into account the patient’s lived experience. She described her personal experience as not by the book.
Joy Jenrette, an Atlanta-based lawyer, shared the importance of a support system and complete information on understanding the diagnosis.
Understand the history of racism and violence within the American medical and research systems
Engage and educate providers on Black women’s views of medical mistrust to address modifiable provider level factors that may ease or diminish such feelings (Sutton et al, 2019)
Train, recruit and retain providers from diverse backgrounds
Integrate Black patients/patient experts into the leadership structure of the care environment
Additional work on AL and epigenetic on breast cancer in Black women
Integrate patient expertise into research protocols
Be accurate and give the most accurate information about a patient’s diagnosis
Make sure your patient is aware of ALL genetic testing, clinical trials and treatment options available to them.
Women are not advised to get a mammogram until they are 40 years old, but if you have a family history of breast cancer, it is extremely important that you get your mammograms before the age of 40 and also the importance of getting the genetic testing as well.
Bring a journal to appointments. Take note of doctor’s names and other key information.
Get a second opinion when the doctor is looking at the case from a different perspective.
Research doctor referrals.
During genetic testing, look at maternal and paternal sides of your family that could possibly have a history of breast cancer.
Medicine is constantly changing and advancing. Document experiences with various medications to share with providers. Ask about new medical advances or treatment options.
The Tigerlily Foundation and Guiding Researchers and Advocates for Scientific Partnerships (GRASP) November conversation was co-hosted by keynote speaker, Mr. Shawn Johnson, a medical student in the Pathways M.D. program at Harvard Medical School, and our patient experts, La’Kesha Jackson-Gordon, LaTayla Palmer, Tova Parker, Na’Diah Smith and Temi Omaghomi. The panelists focused on what it means to have “Cancer While Black: Moving Past the Medical Mistrust Impact”.
Shawn Johnson presented on the role of institutions creating and supporting health disparities in structural racism. While the conversation tends to shift to a particular group, Shawn challenged the audience to place the focus on healthcare institutions. He described four types of racism: personal, interpersonal, institutional and structural.
Personal: private beliefs, prejudices & ideas that individuals have
Interpersonal: the expression of racism between individuals
Institutional: discriminatory treatment, policies & practices, within organizations & institutions
Structural: system in which public policies, institutional practices and other norms perpetuate racial group inequality
Mr. Johnson described the history of healthcare segregation in the United States highlighting the passage of medicare and medicaid in 1965. Civil Rights advocates traveled the country ensuring hospitals integrated and provided access to Black patients. Mr. Johnson explained how Black patients have been hypersegregated in low-quality, high-cost hospitals despite the Affordable Care Act. The data shared during his presentation showed how Black people have lacked the opportunity to receive high quality healthcare that is affordable, which has impacted many Black women with breast cancer vying for access to proper treatment options. Black patients have been shuttled into second tier healthcare systems for decades. For example, while 25% of Boston, MA residents are Black only 5% of patients at the Dana Farber Cancer Institute are Black compared to 50% at Boston Medical Center. New disparities are created daily because any socio-economic disparity is automatically a racial disparity. The cost of a cancer drug in 1975 was $120/month. The same cancer drug in 2015 was $10,000/month. Yes, breast cancer disparities are a civil rights issue.
LaTayla Palmer-Lewis, a transformational coach, expressed her concern that lives are being lost because healthcare professionals are not listening. Sharing a personal story of her younger sister’s journey, LaTayla explained the lengths her sister had to undergo in order to receive a mammogram despite an extensive family history of breast cancer. When LaTayla’s sister finally received her order for a mammogram, she was diagnosed with breast cancer.
Tova Parker, Founder of Pretty (sic), echoed that healthcare professionals need empathy for patients. Patients are more than a statistic. Tova Parker shared about being diagnosed at 41 with Stage III triple negative Invasive ductal carcinoma (IDC), with no family history or a genetic mutation. Tova started mammograms at 36 years old thanks to a physician that felt strongly that Black women should start earlier than the guidelines. When Tova moved to Texas she experienced a doctor that would cut her off when she would voice her concerns, Tova speaks about how she had to advocate for herself as a Black woman her entire life, so this was no different.
La’Kesha Jackson-Gordon, Founder of Pink Shoes, stated “I want to be seen as a person who will survive this disease”. She shared her challenges with health insurance impeding her progress by being forced to wait for her medication to be approved. She expressed that although insured, La’Kesha still had to pay a lot out of pocket expenses not covered by her health insurance. La’kesha described the burden on patients to find resources, follow up with insurance/physicians and advocate for themselves. Most places that take uninsured/underinsured patients don’t have navigators or offer help to patients to find resources or assist in personalized advocacy. With knowledge of systemic racism/inequities, makes it hard to trust what physicians tell you (or don’t tell you).
Na’Diah Smith, Founder of Pretty Fit Survivor, agreed and detailed the emotions shared by many patients between feeling overwhelmed and angry. She insisted that allies of different groups step up to the plate. No one group can tackle the healthcare institution alone. In order for change to take place, Na’Diah asked for groups to come together around this common goal. Na’Diah Smith stated that having a breast surgeon that was a woman of color positively impacted her journey as a breast cancer patient. The HCP became her advocate, but Na’Diah still had to do a lot of the legwork and research to make decisions about her treatments. Like most Black women, Na’Diah was never asked to participate in any clinical trials and she was not treated like someone who would survive breast cancer. Na’Diah brings up the fact that in Black communities there is a resistance and discomfort with talking about illness. How can we solve this?
Temi Omaghomi, a compliance analyst and aspiring genetic counselor, demanded more personalized care. “I had to be my own nurse. I had to be my own social worker. The healthcare providers could have helped with that” she said. Temi who is only 23 years old was diagnosed in 2020. Temi did not only struggle with treatment due to her race but also her age. Temi struggled with doctors not taking her seriously and emphasized that young women can get breast cancer as well. Temi fired two doctors while searching for a doctor who cared. Temi shared her own experience with therapy which has helped her emotionally. Her remarks remained a common thread throughout the conversation. It does not have to be.
Patients should not have to fight against sub-par care while battling for their lives
Allies need to help dismantle the institutional racism that exists within the healthcare system.
“Fighting is the last term I want to think about when going to a healthcare professional.” – Dr. Arnethea Sutton
The Tigerlily Foundation and Guiding Researchers and Advocates for Scientific Partnerships (GRASP) launched a monthly conversation series entitled #KnowMoreDisparities and #PullUpASeat. Our first conversation was held in September 2020 on the topic of addressing clinical trials and healthcare practices. Facilitated by our keynote speaker, Dr. Arnethea Sutton, a postdoctoral fellow at Virginia Commonwealth University School of Medicine, and patient experts Sheila McGlown, Jamil Rivers, Angela Baker, Roberta Albany, Nunny Reece and Shonte Drakeford, the conversation started with the definitions of biases and ended with a charge to change the impact of bias on healthcare treatment for Black women.
Dr. Sutton’s presentation provided present day examples of bias overheard by medical students and physicians alike. According to Merriam-Webster Dictionary, a bias is “an inclination of temperament or personal outlook of sometimes unreasoned judgment.” Dr. Sutton challenged the audience to move past the term – bias rather referring to the unequal treatment of Black patients as racism.
Implicit bias is a feel good term to make others feel ok which sounds passive yet the impact can be fatal. – Dr. Arnethea Sutton
What is unconscious is learned and drenched in stereotypes. This unconscious learning has led to health disparities. Health disparity is the higher burden of illness, injury, disability, or mortality experienced by one group relative to another. Amongst studies that observed the relationship between implicit bias and outcomes, nearly 43% of studies found that increased implicit bias equaled disparities in treatment recommendations, empathy and pain management. Of the studies that assessed implicit bias and patient-provider interactions, 100% of studies found a stronger implicit bias led to a decrease in poorer patient provider communication. Dr. Sutton’s presentation was supported by data and outlined the way forward for healthcare professionals which includes implicit bias training, chief equity/diversity officers, a diversified workforce pipeline, patient-level interventions and provider-level interventions.
Jamil Rivers, Founder of The Chrysalis Initiative, Chief Financial Officer of Education Works and a Tigerlily Foundation Angel Advocate, shared her personal story and reflections from Dr. Sutton’s presentation stating that “at this point we can’t train racism away but you [healthcare providers] should respect me”. Jamil suggested an accountability system for health equity plans that demonstrates goals are being met prior to receiving grant and policy funding.
“My life should not be contingent on racism from a person”, Jamil continued.Since Black women are a high risk group, she emphasized the need for a unique personalized plan to treat breast cancer. There should be no diagnostic delays.
Sheila McGlown, a 25 year Air Force veteran and 10 year MBC patient advocate, chimed in and asked allies to see her as human. “Treat me as I’m living not as I’m dying.” Sheila desires medical professionals to be passionate about her health with the same passion as when caring for a white woman. This starts with appropriate medical school training. She charged medical schools to invite Black women into the classroom to share patient experiences. It has been over five years with a consistently high mortality rate for Black women with breast cancer. Sheila encouraged the audience to work as a collective to reduce this number because something is wrong.
Jersi Baker, Founder of Angel in Disguise, was diagnosed with MBC in 2011. She was referred to palliative care and a social worker nine years later. Jersi questioned why her pain did not matter and left the audience with this statement, “Stop pimping us and start partnering with us.”
Shonte Drakeford, a healthcare provider and patient, shared that her goals have always been to help people in underprivileged communities. Due to her military background, Shonte experienced first hand the stark difference in healthcare treatment based on location. This should not be the case. She implored healthcare professionals to check their colleagues. “Don’t be complacent,” Sheila said “Help change the percentages of deaths within the Black community.”
Roberta Albany, a Susan G. Komen advocate, in Science and Membership Committee Member, concluded the conversation by stating healthcare providers need to build a relationship with Black and Brown populations to change the narrative. Every patient’s issue is important.
Patient advocate participation must be a prerequisite for cancer centers and other healthcare institutions to receive funding for clinical trials.
Patient advocates should be required participants when developing clinical trials.
Diverse patient-centered experience training should be offered in medical schools.
Of the more than 200 different types of cancers, breast cancer remains the most common. It is important to note that breast cancer does not affect all men and women the same. Even living in North America, unfortunately still impacts their access to care. As researchers work to address disparities it remains critical to look at communities at the grassroots level. Tigerlily Foundation and American Association for Cancer Research (AACR) hosted a special session at the 2020 San Antonio Breast Cancer Symposium that addressed the importance of health, collaboration and partnership with Black, Indigenous and people of color (BIPOC). The numerous research studies shared during our special sessions suggest that the primary reasons for breast cancer-related health disparities are rooted in large part by socio-economic differences. However, even the most educated and economically advantaged Black, Indigenous and persons of color (BIPOC) have a higher prognosis of cancer compared to White women. Tigerlily Foundation is committed to working with medical researchers and professionals to address racial and socio-economic disparities in breast cancer care. Sharing these findings with you, as an advocate and ally, is part of our mission to end disparities – of age, stage and color, in our lifetime.
Where You Live Impacts Your Cancer Survival
The University of Miami and Florida International University are the first to use a new measure, the Index of Concentration at the Extremes (ICE), to analyze the effects of economics and the neighborhood you live in (racial/ethnic residential segregation) on breast cancer survival in South Florida. The study looked at 6,145 breast cancer patients from South Florida.
With over 52% Hispanic, 26.3% Non-Hispanic Whites (NHW), and 17.2% Non-Hispanic Blacks (NHB) represented, the study revealed that women with breast cancer living in extreme poverty had a significantly greater chance of dying from the disease.
In conclusion, The University of Miami and Florida International University found that breast cancer survival disparities are partly influenced by extreme racial/ethnic residential and economic segregation. When accounting for socio-demographics, tumor characteristics, the guideline for appropriate treatment from the National Comprehensive Cancer Network (NCCN), disparities remained. This suggests potential social and environmental factors that impact survival. Further supporting the need for effective interventions that account for the social and environmental contexts in which cancer patients live and are treated.
Tigerlily Foundation’s Points to Consider:
Are there any other studies like this happening anywhere else in the United States?
What will be the impact COVID-19 has on the already overwhelmed health care system in underserved communities that work with and serve individuals in extreme poverty?
Where you live matters: Impact of economic, racial/ethnic, and racialized economic residential segregation on breast cancer survival – Goel N, Kelly KN, Yadegarynia S, Choi S, Kesmodel SB, Westrick A. University of Miami, Miami, FL; Florida International University, Miami, FL.
Racial Disparities in Breast Cancer Screening
In another study by Johns Hopkins University in Baltimore, Maryland they assessed 140,346 women between 2013-2020. Researchers tracked breast cancer screening methods, focusing on racial differences in utilization and effectiveness. The use of Digital Breast Tomosynthesis (DBT), a more effective screening technique compared to traditional two-dimensional digital mammography (FFDM), rapidly increased over the study period, however, Black and Asian women were less likely to have had a screening with DBT compared to White women.
Racial disparities persist despite with uptake of digital breast tomosynthesis (DBT) for breast cancer screening – Ambinder EB, Oluyemi E, Visvanathan K. Johns Hopkins, Baltimore, MD
Tigerlily Foundation’s Points to Consider:
While screening rates between Black and White women are similar, the modalities of screening vary. Research data shows that healthcare is segregated, possibly driven by racial differences in sites of care.
DBT is not offered widely. The detection advantage of DBT vs. FFDM is most prominent for women with dense breasts. There is evidence that Black and Asian women have more dense breasts than White women, if age and body mass index (BMI) are adjusted in the study.
We would like to understand if the patients were able to access 3D mammograms without a referral from their healthcare provider? Is access based on availability or non-referrals?
Reducing Racial Disparities in Oncoplastic Surgery
Here is a study from the National Surgical Quality Improvement Program (NSQIP) looking at 180,700 women who underwent Breast Conservation Surgery (BCS). They identified through the database between 2008-2018, racial differences in BCS utilization rates (partial mastectomy and oncoplastic/reconstructive surgery) that were examined to determine how the rates changed over the period of time. Of the 46% of women who underwent BCS, 92% underwent a partial mastectomy and 8% received oncoplastic procedures.
The proportion of patients having oncoplastics increased from 3.5% in 2008 to 10% in 2018, leading to a declining proportion of partial mastectomies: 96.5% to 90.0%. Overall, oncoplastic utilization between 2008 and 2018 increased from 4% to 10% in Asian and White patients, and 1% to 10% in Black patients.
The racial index of disparity for BCS patients decreased from 17.1% to 9.7%; while the index of disparity has remained relatively unchanged for partial mastectomies (1.2% to 0.2%), but significantly decreased in oncoplastics (35% to 1.6%) indicating an improvement in racial disparities for oncoplastic procedures. This study demonstrates promising progress within the field of breast conservation surgery with a decreasing index of disparity among races especially in oncoplastic surgery.
Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery – Jean J, Jonczyk MM, Homsy C, Naber S, Chatterjee A. Tufts University School of Medicine, Boston, MA; Tufts Medical Center, Boston, MA.
Tigerlily Foundation’s Points to Consider:
What caused a significant decrease of racial disparities in oncoplastics but not partial mastectomies?
Was information and options provided by the patients’ health care provider?
Were regional differences apparent for mastectomy and partial mastectomy rates?
Triple-Negative Breast Cancer Rates Higher Among African-Ancestry Patients
The University of Chicago performed a study on genomic and transcriptomic sequencing of breast tumors comparing 221 AA and 341 EA patients at the molecular level. While the biological drivers behind this disparity remain unknown between ancestral populations, EA TNBC patients in comparison to AA TNBC patients exhibited higher mutation rates in certain tumors such as BRCA2, HR-/HER2+ and FGF3.
The study’s results concluded that there were significant differences in breast tumor heterogeneity and mutation spectrum in TNBC and HR+/HER2- breast cancers between AA and EA patients. Additionally, ancestral differences were also observed in the activity of relevant signaling pathways for TNBC. Overall, the results identify previously unexplored pathways and molecular phenotypes of aggressive disease, providing opportunities for development of more effective biomarker informed treatment of breast cancer in diverse populations.
More comprehensive research and case studies need to be implemented on African-Ancestry (AA) patients. Not having this understanding of how the disease impacts AA patients, it can become more aggressive and causes a higher mortality rate.
Comprehensive genomic and transcriptomic profiling of molecular subtypes reveal ancestral differences in the activity of signaling pathways between patients with African and European ancestry – Miyashita M, Bell JSK, Zheng Y, Yoshimatsu T, Rajagopal PD, Woodard A, Reynier JB, Sveen E, Khramtsova G, Liu F, Ibraheem A, Fleming G, Jaskowiak N, Nanda R, Leibowitz B, Beaubier N, White K, Huo D, Olopade OI. The University of Chicago, Chicago, IL; Tempus Inc, Chicago, IL.
Tigerlily Foundation’s Points to Consider:
How do we encourage the scientific community to create more clinical trials that address genomic and transcriptomic sequencing?
How do we support access and patient confidence in clinical trials, in particular ensuring that we have enough patients in African-Ancestry?
Racial Differences in Breast Cancer Immune Microenvironments
The rate of mortality among Black women is 40% higher than among White women. Although, the cause of this staggering difference is still not completely understood, a growing body of evidence leads scientists to take a closer look at the immune microenvironment (the interaction between cancer cells and other cells within and around a tumor) to find answers.
The authors used the Carolina Breast Cancer Study (CBCS), a large population-based study, and a test they created to identify 48-genes from 13 immune cell types in 1,957 breast cancer patients, including 53% Black and 47% non-Black women. The study identified three breast cancer phenotypes defined by the level of activity of the immune microenvironment which correlated to risk of recurrence, intrinsic subtype, age and race. Immune response differences may be targetable to improve treatment response, and therefore it is important to identify race- and subtype-specific differences in immune microenvironments as these are the two most notable differences in this study.
Racial differences in breast cancer immune microenvironments – Hamilton AM, Olsson LT, Calhoun BC, Hoadley KA, Troester MA. University of North Carolina at Chapel Hill, Chapel Hill, NC.
Tigerlily Foundation’s Points to Consider:
How can we tailor cancer treatment specific to race sub-type and immune microenvironments?
Racial Disparities in long-term Survival after Chemotherapy
Pathological complete response (pCR) is a strong predictor of long-term survival among breast cancer patients who receive chemotherapy before undergoing surgery. pCR occurs when the tissue no longer contains any cancer cells after treatment with chemotherapy then surgery. In a study by the University of Chicago, they looked at 595 stage I-III breast cancer patients. Researchers sought to determine whether racial disparity existed in the rate of pCR. The results of the study showed that significantly fewer Black patients achieved pCR than White patients.
Even after adjusting for tumor subtype and clinical stage, Black patients still had a much lower chance of achieving pCR after neoadjuvant chemotherapy. While the delayed initiation of treatment might have partially contributed to the racial disparity, black women with hormone receptor negative, HER2 positive breast cancer had the largest disparity.
Researchers concluded additional investigation is required as this study was quite small.
Racial disparities in pathological complete response among breast cancer patients receiving neoadjuvant chemotherapy – Zhao F, Steiner M, Ibraheem A, Fleming G, Jaskowiak N, Nanda R, Olopade OI, Huo D. University of Chicago, Chicago, IL.
Tigerlily Foundation’s Point to Consider:
Clinical trial involvement should be encouraged within the Black community. On average, Black women do not have complete pathologic responses to neoadjuvant chemo, which reemphasizes the inherent biological differences Blacks have in response to available therapeutics.
Did you know Gene Expression Differs Between West African and East African Breast Tumors?
Global frequency of triple-negative breast cancer (TNBC) reveals a unique pattern that suggests there may be genetic increased risk specific to TNBC.
In a recent study, West African and African-American women were associated with higher rates of TNBC than East African women and White American women. Even within TNBC cases, outcomes differ between race groups, which may be due to differences in TNBC subtypes/biology, related to genetic ancestry. The study sought to determine the difference in genetic expression and TNBC tumor environments in two distinct ways (race vs. ancestry). The study looked at Ghanaian (West African) and Ethiopian (East African) by analyzing gene expressions. Scientists found hundreds of genes differentially expressed in TNBC tumors between the two groups.
This important ground-breaking study is first of its kind and demonstrates the need for deeper research in African ancestry.
Martini R, Gebregzabher E, Dorsaint P, Chu T, Arora K, Gibbs L, Manojlovic Z, Robine N, Sboner A, Elemento O, Carpten J, Newman L, Davis M. Weill Cornell Medical College, New York City, NY; New York Genome Center, New York City, NY; University of Southern California, Los Angeles, CA.
Tigerlily Foundation’s Points to Consider:
Tigerlily Foundation and its partners encourage and support further research and development in this area.
Does the data vary by group based for all stages of disease (early-stage vs metastatic)? Is there a survival difference based on race or ancestry and the associated genes?
The possible genetic variation between West and East African.
The Impact of Medicaid Expansion on the Gap between American Indians and Whites on Breast Cancer Management and Prognosis
Significant disparities in outcome exist between American Indian (Indigenous) and White populations. Between 1999 and 2009, breast cancer-related death rates did not decline significantly among American Indians (Indigenous) compared to Whites.
While insurance coverage undoubtedly plays a vital role in ensuring access to preventative services and breast cancer care, it is uncertain how this may affect patient outcomes. When the Affordable Care Act of 2010 rolled out the Medicaid Expansion, a larger percentage of the population gained access to health insurance coverage.
A group of researchers sought to determine how this expansion affected breast cancer management and prognosis for American Indians (Indigenous) compared to Whites. The study results were mixed. While early breast cancer diagnosis increased among American Indians (Indigenous), 3-year mortality rates did not change.
Tigerlily Foundation’s Points to Consider:
Tigerlily Foundation and partners recognize the disparities in health care impacting the Indigenous population across the United States. It is not acceptable that the 3-year mortality rate did not change, even with greater access to Medicaid.
Did Medicaid expansion under the Affordable Care Act narrow the gap between American Indians and Whites on breast cancer management and prognosis? – Gaba AG, Cao L, Renfrew R, Egland KA, Witte DL, Wernisch J, Crosby R. Sanford Roger Maris Cancer Center, Fargo ND; Sanford Research, Fargo, ND; Sanford Health, Fargo, ND; SAb Biotherapeutics, Sioux Falls, SD; Sanford Research, Sioux Falls, SD; Sanford Center for Biobehavioral Research, Fargo, ND.
Impact of Medicaid Expansion on Breast Reconstruction in Low-Income Breast Cancer Patients
Researchers studied Ohio women (low income, 30–64-year-old, newly diagnosed) with local or regional spread of breast cancer in the post-Medicaid expansion between 2014-2016. This study was to determine whether the Time To initiation of Treatment (TTT) following a breast cancer diagnosis decreased. This research is important since significant delays in TTT can affect quality of life and increase mortality rates.
Using data from the Northeast Ohio Cancer Assessment and Surveillance Engine (NEO-CASE), researchers identified 30–64-year-old women with a new diagnosis of invasive, non-metastatic BC who were uninsured or on Medicaid when diagnosed, excluding women with incomes above 138% of Federal Poverty Level. Though no significant change in TTT was observed, the percentage of uninsured in the low-income group fell by more than half. The percent of women undergoing reconstructive surgery increased from the pre-to the post-Medicaid expansion period, a change not observed in the privately insured control group. Overall, TTT increased by 2 days post-expansion which is statistically insignificant.
Despite the lack of improvements in TTT, the study notes the drop in the percentage of uninsured BC patient’s post-expansion. They also noticed a decrease in the percentage of women diagnosed with regional-stage disease. Lastly, they noticed an increase in BC patients undergoing reconstruction. Taken together, these trends show an overall positive impact of Medicaid expansion on BC process of care and outcome measures.
Medicaid expansion associated with earlier stage and improved reconstruction rates in low income breast cancer patients – Rose J, Dong W, Kim U, Obeng-Gyasi S, Koroukian S. Case Western Reserve University, Cleveland, OH; Ohio State University Medical Center, Columbus, OH.
Tigerlily Foundation’s Points to Consider:
Would the United States benefit from a healthcare system similar to Canada, Norway and Sweden?
What would this cost and how would you implement it?
Impact of Medicaid Expansion on Racial Disparities and Initiation of Chemotherapy Treatment
When patients receive late adjuvant chemotherapy, the harder it is for the body to fight the disease even with medical intervention. There is a greater risk of the cancer spreading. Racial and ethnic minorities, uninsured populations, and low-income patients experience such delays far more often.
A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. This study evaluates the impact of Medicaid expansion on racial disparities in time to adjuvant chemotherapy administration. The study looked at 105,385 patients (aged 40-64) diagnosed with primary invasive BC (stage I-III) between 01/01/2007 and 12/31/2016 identified in the National Cancer Database.
Of the total sample size 71.8% (75,663) were diagnosed in the pre-Medicaid expansion period and 28.2% (29,722) in the post- Medicaid expansion period. The racial breakdown includes 77.5% White, 11.7% Black and 4.9% Hispanic patients. In both study periods Blacks and Hispanics experienced chemotherapy initiation delays compared to Whites. The proportion of chemotherapy delays decreased for all races between the pre- and the post-expansion period.
Researchers observed a statistically significant decrease in racial disparity in the chemotherapy initiation and demonstrated that Medicaid expansion reduced racial disparities. This in turn decreased the proportion of Blacks and Hispanics experiencing delays in adjuvant chemotherapy initiation and the gap that exists when compared to Whites.
Impact of Medicaid expansion on racial disparities in time to adjuvant chemotherapy administration among breast cancer (BC) patients Chavez-MacGregor M, Lei X, Zhao H, Shih T, Giordano SH. The University of Texas MD Anderson Cancer Center, Houston, TX.
Tigerlily Foundation’s Points to Consider:
Many of the Southern states that have the largest Black populations chose not to expand Medicaid under the Affordable Care Act.
11 Million undocumented immigrants not covered by the Affordable Care Act.
How do Socioeconomic, Demographic, and Genomic Factors Affect Breast Cancer Mortality?
Studies have shown that health services, socio-demographic, clinical, and genomic factors all contribute to breast cancer disparities. The degree to which each factor contributes to health outcomes in cancer is uncertain.
In a retrospective study (a study of past data) used Formalin-Fixed Paraffin-Embedded (FFPE) breast cancer (BC) tissue collected between 1992-2006 within the Iowa and Hawaii (SEER Residual Tissue Repositories). Researchers created the first-in-kind linkage of SEER-Medicare data to physical tumor samples to combine clinical, health services, and genomic data into a single group. This linkage allows genomic analyses with clinical and health services data.
Researchers anticipate that this analysis method may offer new ways to explain links between biology, access, and disparities in breast cancer outcomes.
Comprehensive analysis of health services, sociodemographic, clinical, and genomic factors driving locally advanced breast cancer mortality via a first-in-kind linkage of SEER-Medicare data with physical tumor samples Robinson TJ, Wilson L, Marcom PK, Troester M, Lynch CF, Hernandez B, Castellar EP, Brauer HA, Enewold L, Dinan M. H. Lee Moffitt Cancer Center, Tampa, FL; Duke University Medical Center, Durham, NC; University North Carolina Chapel Hill, Chapel Hill, NC; University of Iowa, Des Moines, IA; University of Hawaii Cancer Center, Honolulu, HI; Gates Foundation, Seattle, WA; NIH, Bethesda, MD.
Tigerlily Foundation’s Points to Consider:
How do encourage more industries and Key Opinion Leaders (KOL) to sign the #InclusionPledge and extending to our social and family networks to get involved.
This article was co-authored and peer reviewed by Erica Warner, ScD, MPH; Arnethea Sutton, Ph.D.; Onyinye D. Balogun, M.D., Melissa Davis, PhD; Ogori N. Kalu, MD, Maimah Karmo, Diana Porter Bodden, Shanda Cooper, MSc., Tania Koulakian and Jacqueline Seylmes.
“I did enjoy the session. Although there is a long way to go to end disparities, it seems that studies and research are asking questions that will inform steps that can be taken to improve outcomes.”
“Much new evidence and research was presented, as well as new hypotheses and explanations offered for disparities.”
“The “voices” included were largely research studies or from clinicians. The information included was relevant and directly important to patients, but I didn’t feel like the patient voice was necessarily included.”
“I am aware that breast cancer outcomes might be improving, but significant disparities exist in that improvement. I felt this presentation was a hopeful step in getting to the root causes in order to eliminate these disparities. Changes in screening, treatment, access and understanding of tumor biology were all proposed. The field of social stressors, allostatic load, and social epigenetics were raised, but leave room for further investigation and discussion.”
One of the most ancient tools for healing, used around the globe, is an instrument that is compact, inexpensive, and innate: the human voice. Let’s dive into practical tools that you can apply to create harmony from the inside out.
Go ahead and take a deep breath in, then let it out with a sigh or audible yawn. Perhaps create an elongated sound of “AH” on your exhale. This is not meant to be pretty. Instead this sound is one of active release. Try creating the open vowel “AH” a few more times, experimenting with volume, pitch (high/low sound) and duration. You might explore making different sounds one at a time such as “UH” “OOO” “EH” “EYE” “AUM” etc. Creating defined sounds in an intentional way with the voice is called vocal toning. It is important to release judgement, and see this as a fun experiment. Find out what feels good and natural for you!
What do you experience in your body when you engage your voice? How and where do you feel the sound vibration? Does it travel, does it seem isolated to one region? Perhaps try placing your hand upon the area of the chest or belly while making a sound. lf you turn your awareness inward, what sensations, both physical and emotional do you notice?
Using sound for therapeutic outcomes begins with setting an intention to be carried through the vibration. What are you looking to bring into your life today, what sentiment are you offering yourself or others? Care, attention, forgiveness, love?
Now gently begin to hum, by slightly pursing your lips and keeping your tongue to the upper palate. Focus on directing an “MMM” sound to the front of your face. From there you can direct the sound to different regions of the body. Perhaps to areas that feel tight or tense. There is no wrong way to do this. The voice is intuitive and wise all by itself. The first step is trusting what comes out naturally.
Now you might be wondering, where is the science-based evidence that proves using the voice in this way is effective? Here’s a fun fact: sound travels faster in water because the particles are more densely packed. When sound is made in water the liquid will often change shape and produce intricate patterns. The human body is made of about 60% water, therefore it naturally responds to the effects of sound and can literally reorganize itself based on the sound frequencies it absorbs.
When we hum and create sound through the voice, there are a long list of benefits. Think of the relaxation that can be achieved for those who like to receive massage therapy for aiding pain, tension, or injury. Humming is a vibrational massage for the organs, tissues, and cells!
Research proves that when someone is engaged with humming for prolonged periods (5 min or more) the following begins to take place:
Increased oxygen to the blood, brain, and cells
Lowered blood pressure and heart rate
Activating the parasympathetic nervous system (responsible for rest & digest response)
Release of oxytocin (hormone responsible for feelings of love, trust, and belonging)
Increase of nitric oxide (neural transmitter that creates lymphatic circulation, boosts immune system, and relaxes the muscles)
Release of endorphins (creates a lift in energy and blocks pain receptors)
Production of melatonin (sleep hormone that aids relaxation, natural anti-aging and anti-inflammatory)
The list goes on! For further reading I highly recommend a book by leading pioneers in western sound medicine The Humming Effect by Jonathan Goldman and Andi Goldman found here.
The voice is a deeply personal and powerful tool. It is always there for you. Next time you find yourself in a stressful moment, perhaps tune into the sounds you can detect, take a breath, and begin to hum for a few minutes. Notice how quickly your energy shifts. Heightened emotions such as stress, fear, worry, can be soothed by being transformed into soundwaves. You could also make sound with the intention of projecting a vibration of love or peace out across the planet. Sound has the power to disperse your intention. Composer, sound therapist and researcher Steven Halpern said “sound is the carrier wave of consciousness.”
To deepen your journey of healing with sound, join me for a weekly self love sound bath hosted by Tigerlily Foundation. Enjoy the soothing vibrations of crystal singing bowls, chimes, guitar and more, while experimenting with simple vocal toning and humming exercises. May you stay curious, and unleash the healing benefits of sound through the power of your own voice!
PART 1: Sound as a Tool for Healing, Harmony, and Wellbeing
As a singer-songwriter and certified sound therapy practitioner, my work is centered around the power of sound and its impact on the physical, mental, emotional, and energetic body.
Sound is an ancient form of medicine, used for centuries to support wellbeing and accompany various stages of life. In what ways can sound be therapeutic and why is the human body sensitive to sound? Certain frequencies have been proven to create lasting benefits when applied with intention, including reducing stress, soothing pain, releasing emotional stagnation, improving sleep, boosting immunity, and encouraging cellular rejuvenation. How does this research relate to your own life? Think of a time when music shifted the energy of a moment. Perhaps at a ceremony, a concert, or at home during this pandemic. How were you supported or affected by the sound in your environment? Sound can have both a subtle and monumental impact on one’s mood, physiological responses, and sense of connection with others.
If you tune in right now: what can you hear or what vibration can you feel? There is likely a symphony of sound surrounding you, which can easily be drowned out by the noise of thoughts. So take a moment, take a breath, maybe close your eyes and begin to listen in a deeper way. Perhaps you can sense the singing of birds, the movement of traffic, another human voice, or the low hum of a nearby appliance.
Many people think of music as being made exclusively by those who identify as musicians. Perhaps they even go as far as declaring, “I am not musical.” And yet, every human being is born with the innate gift of sound, vibration, and rhythm. The first thing that a child does when they arrive into the world is make sound through crying. Vibration is a primary mode of communication for the infant and parents alike. Secondly, each of us carries around an inner drum that sustains us at all times. You guessed it, the heart. From a musical perspective, the heart is like a metronome, a natural keeper of time. The heart helps all the other organs function in a cohesive and mutually rhythmic way.
Science proves that everything that is in motion has a vibration. Therefore, every tissue, bone, and cell in the human body emits its own unique vibration and frequency. The brain is part of this equation too! The neural pathways communicate by sending messages through small electrical pulses. Essentially, the human body is a living breathing symphony. Music is often defined as “organized sound” and the body is one of the most organized instruments out there! So if you still don’t believe that you are musical, linger a while longer.
When it comes to health and wellbeing, just as an instrument can go out of tune, so can the human body. When the body is functioning with mental, physical, and emotional equilibrium harmony is achieved. In an orchestra when one instrument is playing out of tune, something begins to sound “off,” which is called dissonance. The same is true for the human body. Inner dissonance occurs when a particular region is not functioning in balance with the whole. This disharmony can result in fatigue, pain, discomfort, and illness. Sound and the use of the voice can be a primary tool in helping to restore and preserve the natural state of harmony required for rejuvenation and healing. Think of it as re-tuning the body, mind, and spirit. When we look at the current research as well as personal accounts of the effects of sound on holistic health, it is not surprising that Albert Einstein predicted, “Medicine of the future will be the medicine of frequencies.” The field of sound therapy is ancient and yet there is still so much to uncover.
Keep an eye out for next week’s blog focused on the power of the voice and the many ways you can engage your inner instrument to ignite balance and harmony in your life.
Experience a Sound Bath LIVE with Michaela every Thursday at 7pm on Zoom. Click here to register.
Last week, I took a new fitness class via Zoom. It was a special offering for breast cancer patients and survivors. At the end of the class, the instructor offered some words of encouragement for us. He reminded us of what we’d all been through – the devastating diagnosis, the grief, the pain, the doing of hard things, the chemo, the recovery, the scars. Each one of us had come through all of that, and he wanted to remind us of the strength we had had to endure it. He urged us to build on that, not to forget about or throw away what had been hard-earned through our cancer ordeals, that we should have confidence in our future abilities because of what we’d already survived.
With the words, “Don’t throw away,” my mind immediately jumped to Hebrews 10:35-36, which starts with, “So do not throw away your confidence.” I had memorized those verses through a song as a child but had never really thought about what they meant beyond the reference to perseverance. In their entirety, they read, “So do not throw away your confidence; it will be richly rewarded. You need to persevere so that when you have done the will of God, you will receive what He has promised” (NIV).
This concept of having confidence to face trials wasn’t new to me. Whenever I share my testimony, I share how God’s movement in my life through my divorce and years alone revealed His character to me and demonstrated that I could, in fact, go through things I would never have imagined I could survive – in His strength. And that once you’ve seen God faithfully carry you through something awful, you have confidence later that He will carry you through the next thing. I face cancer with less fear than I might have because I saw Him work so mightily in me through these other trials.
But apparently I didn’t need to learn all that from personal experience. I could have just read the verses right before those in the song I was so familiar with.
Remember those earlier days after you had received the light, when you endured in a great conflict full of suffering. Sometimes you were publicly exposed to insult and persecution; at other times you stood side by side with those who were so treated. You suffered along with those in prison and joyfully accepted the confiscation of your property, because you knew that you yourselves had better and lasting possessions. So do not throw away your confidence; it will be richly rewarded. You need to persevere so that when you have done the will of God, you will receive what he has promised (Heb. 10: 32-36).
Hebrews says: Remember your suffering and how God carried you through. Let that inform the future suffering you encounter. Don’t throw away your confidence; let it embolden you. You can do all things through Christ. Even this. God will carry you through once again. And He will even reward you if you persevere. Win-win.