Category Archives: Cancer

Cancer & Patients’ Debts

        Many cancer patients are deep in debt because they cannot cover the costs of treatment as well as the other cancer care related expenses.  This information comes from a report at the ESMO Asia 2016 Congress in Singapore.

        In previous studies it has been well demonstrated that cancer patients are facing financial difficulties, even in countries where the national public health system covers most of the expenses.  Patients and survivors experience the economic hardship referred to as the “financial toxicity” of cancer. This study shows new aspects of the burden of cancer care on patients.

       Malaysia’s study found that more than half of cancer survivors spend at least 1/3 of their yearly household income on treatment and costs such as transport to the hospital and childcare.  Many are not funded by the government despite the availability of free healthcare and have to pay for the cancer drugs.

        Nirmala Bhoo Pathy, lead author and a clinical epidemiologist at the Faculty of Medicine from the University Malaya Medical Center in Kuala Lumpur, Malaysia says that the scope of cancer care and drugs offered free through the public health services is limited in Malaysia and the current system of funding for cancer needs to be reviewed.

         A lack of health insurance, low-income and not having surgery were among the factors associated with patients having money issues.  For those who did not undergo chemotherapy the risk was lower.

         The problems appear even more severe in low-middle and low-income countries where patients often need to cover the costs themselves, even for essential anticancer treatments.  In another study participants completed a questionnaire covering issues including income and employment history, as well as health insurance status. Nearly ¾ reported a reduction in their household income after their diagnosis.  Of the 12 patients who were employed, 10 highlighted changes in their employment conditions such as decreased hours and others were no longer working. One reported they had retired. The loss of work, their loss of income and early retirement all contributes to the financial burden on the household.

          The study intends to provide insight into these costs and assist policymakers in finding ways to reduce this burden on patients.  Another study investigated why the cancer doctors recommend costly cancer drugs. Oncologists were asked to complete an online experiment.  Of the 101 responses it was found that healthcare professionals were more likely to advise the use of drugs that allow patients to live longer and have a higher chance of improving their symptoms.  It was less likely they would recommend drugs with an increased chance of side effects and that would cost patients more. They still favored expensive treatments if they tended to increase a person’s survival time by 2 months or more.

        According to lead author Deme Kanikios, PhD candidate, National Health and Medical Research Council Clinical Trials Centre, University of Sydney in Australia, the Australian oncologists are willing to expose their patients to financial toxicity when recommending expensive unfunded anticancer drugs, but only in cases where the survival benefit is above that of standard care.

       It is important that cancer doctors need to help their patients understand the potential benefits, harms and costs of drugs not subsidized by the government so that the patient can make an informed decision.  The ESMO Magnitude of Clinical Benefit Scale tools can help clinicians better inform patients on how extensive the potential benefit is from a treatment option being considered. This helps to put the evidence into perspective, mitigates against optimist bias and can lead to share decision-making that is better informed.

                                                                                                                                Dr Fredda Branyon

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Colorectal Cancers & Young Adults

            Over the years, I have noticed we have seen more and more young people coming to our clinic, New Hope Unlimited, who have been diagnosed with colorectal cancer. Older age does not seem to be a factor anymore.  

      Matt McMillen recently published a troubling article concerning the rise in colorectal cancers in younger adults.  One young woman had health complaints that were dismissed by 3 different doctors. She had blood in her stool and every doctor dismissed it as if it were fissures or hemorrhoids.  Finally, at age 24 she was diagnosed with stage 3 rectal cancer. She was one of the lucky women to survive after surgery was performed.

      Colon and rectal cancer cases are on the rise in those under the age of 50.  This is a group that is rarely screened for cancer. Rates among the younger people increased by more than 11% between 2004 and 2014.  About 135,000 people will be diagnosed with colorectal cancer in 2016, which includes colon cancer and rectal cancer. The American Cancer Society reports this information.  They also believe that about 1 in 7 will be under the age of 50. The University of Texas MD Anderson Cancer Center researchers predicted last year that cases of colon cancer among those ages 20 to 34 will increase by a staggering 90% by 2030, and the number of rectal cancer diagnoses to more than double.

      This problem is particularly pronounced among certain minority groups, according to Durado Brooks, MD, and managing director of cancer control intervention at the American Cancer Society.  He feels that African-Americans are about twice as likely as whites to be diagnosed before the age of 50 and young Alaska natives are diagnosed at 3 times the rate of whites. There are also rises being seen in European nations and Australia.

      The overall number of young people with it is still small compared with the older people, but younger people are often diagnosed with more advanced disease that requires more aggressive treatment.  Most of the cases report that their doctor told them that they are too young to have colorectal cancer screening and disregard the possibility of colorectal cancer when bleeding is reported to them.  Therefore, the cancer is diagnosed late and makes the cancer worse for the younger people.

      Younger people diagnosed with stage 3 cancer usually do better with the treatment and can tolerate more aggressive treatment than someone in their 80’s who has stage 3 colorectal cancer along with other health problems.  Those who lack insurance often go to an urgent care clinic where they are told not to worry about it. At that point, the pain from colorectal cancer can no longer be ignored and a colonoscopy will reveal a tumor.

      Even the experts aren’t sure why there is a rise of colorectal cancer among the young people.  About 1/3 of the cases can be attributed either to a genetic condition or family history of the disease.  It is unclear for the remaining 2/3rds. There is no large-scale study focused on young people so they don’t know if it’s diet or lack of exercise or some other factors.  It could possibly be the changes in diet over the last few decades as younger people eat a lot more fast food and processed food.

      Guidelines recommend testing for colorectal and other types of cancers starting at age 50.  If you have a family history, start screening much earlier. The family history should go back two generations and include your parents, grandparents, aunts and uncles.  If anyone in your family has had colorectal cancer, you should start testing 10 years before the age at which the youngest person in your family got the disease.

      Recognize and report to your doctor any changes in bowel habits or blood in the stool or rectal area, as well as persistent abdominal cramping or pain.  Be an advocate for yourself and insist your symptoms be taken seriously. Perhaps, even demand a second opinion. Be safe, not sorry!

                                                                                                                                        Dr Fredda Branyon

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Can Frankincense Treat Cancer?

           A recent article written by Zawn Villenes and reviewed by Alana Biggers, MD, MPH, offered some good information on frankincense.  Frankincense oil is derived from the Boswellic tree and has a long history in myth and folk medicine. This was one of the three gifts offered to Jesus by the wise men.  This very well might have been because of its apparent healing powers.

         It is believed by some supporters of herbal medicine, that frankincense offers numerous health benefits.  Frankincense may benefit the controlling of bleeding, speeding up the wound-healing process, improving oral health, fighting inflammatory conditions as arthritis and improving uterine health, with the most promising use as a cancer treatment.  The leading cause of death is cancer, killing 8.2 million people worldwide in 2012. The effectiveness of frankincense is limited, according to research, but early results are promising.

        Boswellic acid is contained in frankincense, which may help fight inflammation that is one of the key processes through which the body fights infection.  As the tissue becomes inflamed, white blood cells arrive to fight infection and the local inflammation causes redness, swelling and heat. Pimples and cellulitis are examples of such inflammation.   The Planta Medica published a 2006 study that found a number of ways the boswellic acid in frankincense might fight infection.  It was also found by researchers that boswellic acid might target free radicals and cytokines that play a role in inflammation.

       It is suggested that the anti-inflammatory properties of frankincense might also be effective in the treatment of rheumatoid arthritis, Crohn’s disease, bronchial asthma and ulcerative colitis.  It may directly attack cancer cells and not just reduce inflammation.

       Chemotherapy kills many healthy cells as it fights cancer and frankincense might target cancer cells without harming healthy cells.  Frankincense affected cultures of normal and cancerous bladder cells in a 2009 study. The oil did target cancerous cells but did not destroy healthy cells.  In 2015 a study found similar effects in breast cancer. These studies are preliminary, however, they do offer hope that frankincense might one day fight some forms of cancer without the potentially life-threatening effects of chemotherapy.

        As always, people should talk to a doctor before trying frankincense or any other essential oil.  This oil is not an alternative to mainstream cancer treatments as no research currently supports using the oil in place of other cancer treatments.

       Some suggestions for the use of this essential oil is in skin care products, soaking in frankincense in a bath tub, using it on pulse points during meditation or yoga and ingesting it after diluting.

       Try adding the oil to honey or another sweetener.  It is cautioned to watch carefully for side effects.  Discontinue immediately if any ill effects develop. If you plan to use it on the skin, a small patch of the skin should first be done.  It can be poisonous even though it is a natural substance. Avoid if you have a history of allergic reactions, weakened immune system, pregnant or lactating.

                                                                                                                                         Dr Fredda Branyon

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Protein-Based Cancer Signature

The University of Basel’s Biozentrum research team has investigated the expression of ribosomal proteins in a range of human tissues, including tumors.  They have discovered a cancer type specific signature and have reported this in Genome Biology.  This cancer signature could potentially be used to predict the progression of the disease.

As we learned in high school biology, it is true that proteins are the building blocks of life. Proteins are produced by molecular machines called ribosomes.  Some eighty ribosomal proteins are contained in human ribosomes.  A research group of Prof. Mihaela Zavolan at the Biozentrum University of Basel has discovered that about ¼ of the ribosomal proteins have tissue-specific expression and different cancer types have their own individual expression pattern of ribosomal proteins.  These patterns may serve as a prognostic marker for cancer and might point towards new therapeutic opportunities.

The Ribosomes are responsible for protein synthesis and are essential for the cell.  It has been assumed that the expression of the individual components of the ribosomes is controlled and invariant, but a few studies have suggested that the expression of individual ribosomal proteins is altered in cancers as well as in diseases of the hematopoietic system, such as acute lymphoblastic leukemia.

The cancer signature has been revealed by systematic data analysis in 30 tissue types, 300 different cell types and 16 different types of tumors, such as lung and breast cancer.  They also found a wide variability in ribosomal protein gene expression as hematopoietic and tumor cells that display the most complex expression pattern.  Consistent signatures emerged for the different cancer types after the analysis of distinct data sets, including patient samples.  The expression of some ribosomal proteins is systematically reduced and others increased in cancer cells.  This would tell us that individual ribosomal proteins could suppress or promote tumorigenesis.

They also discovered a relationship between the signature in breast cancer and the relapse-free survival.  Three ribosomal proteins allow a fairly accurate prognosis of disease progression, comparable to the best predictive markers that are currently known.  This demonstrates the potential of such expression signatures for the prognosis and maybe even a diagnosis of cancer.  They hope to study the functions of individual ribosomal proteins and perhaps opening the door for new therapeutic options.

                                                                                                                                      Dr Fredda Branyon

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New Suppressor Effects In Liver Cancer

And the War On Cancer continues. Here are some results researchers discovered concerning tumor suppression. I’m sorry if this article may seem a little tough to read.

The role of NADPH oxidase NOX4, as an inhibitor of the epithelial-amoeboid transition, has been unveiled by the researchers of the TGS-beta and Cancer group of Bellvitge Biomedical Research Institute (IDIBELL) in collaboration with King’s College London.  This is a process that contributes to the migration and invasion of tumor cells and has been published in the journal Oncogene.

There are previous studies where the researchers suggest that NOX4 acts as a tumor suppressor in the liver, through inhibiting cell proliferation.  According to Dr. Isabel Fabregat, leader of the IDIBELL research group, they have proven that NOX4 is also an important inhibitor of the invasion and metastasis of liver tumor cells.

It has been indicated in vitro studies that NOX4 silencing in liver tumor cells induces a migratory movement that is known as amoeboid.  In relation to cell contractility, the amoeboid movement is regulated by the Rho family of proteins. The increased expression of these proteins results in this type of movement that is associated with aggressive metastases.

It was observed in the study of hepatocellular carcinoma patients that a significant number of cases present NOX4 deletions.  Those patients with a low expression of NOX4 and a high expression of Rho proteins had a much worse prognosis, thus this gives the vitro study a translational relevance as it brings new prognostic biomarkers for this type of cancer.

The TGF-beta cytokine regulates NOX4 at the transcriptional level.  The research group has studied this for more than 15 years and it is known that TGF-beta acts as a tumor suppressor in early stages, but becomes an inductor in late ones.  When the expression levels of NOX4 are low and the Rho proteins are high, the patients could be ideal candidates for this type of drug. NOX4 could not only be used as a marker of poor prognosis but also as a marker for the use of TGF-beta inhibitory drugs.

The main author of the work is Eva Crosas-Molist who was co-directed by Victoria Sanz Moreno from King’s College, and Isabel Fabregat from IDIBELL.  This research will now focus on in-depth study of the molecular mechanisms regulated by NOX4.

-Dr Fredda Branyon

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Excess Weight Helps Colon Cancer Survival

Robert Preidt recently wrote an article that actually supports excess weight in some people.  It has been reported through a new study that overweight colon cancer patients tend to have a better survival rate than their normal-weight peers.

Those who are overweight and obese have been identified as risk factors for any health conditions, but that extra weight may provide protection against mortality for those with colorectal cancer.  This particular study was lead by author Candyce Kroenke, who is a research scientist at Kaiser Permanente Division of Research in Oakland, CA. However, one health expert cautions that the finding is no license for people to pile on all that excess poundage.  Being obese does expose one to higher cancer risks.

Gastroenterologist Dr. Arun Swaminath of Lenox Hill Hospital in New York City says that this study should not be used to describe an “upside” of being overweight with regard to cancer risk, since overweight people develop cancer at higher rates.  

Kroenke’s team examined the medical records of more than 3,400 people in California that were diagnosed with stages 1-3 of colon cancer between the years of 2006 and 2011.  They then compared each patient’s risk of death at the time of diagnosis and then over the following 15 months. Those who were either underweight or statistically obese at diagnosis were more likely to die than normal-weight patients, according to the study.

The people who fell into the overweight but not obese category were 55% less likely to die from colon cancer and 48% less likely to die from any cause than normal-weight patients.  Research has previously shown that overweight and obese people are at higher risk for several types of cancers. This class of people often has better cancer outcomes than the normal-weight patients and are referred to as the “obesity paradox.”  

This observational study represents the largest cohort of colorectal cancer patients with the most comprehensive data regarding patient weight before, at time of, and following diagnosis, which supports the notion of the obesity paradox. Because this is an observational study it cannot prove that weight helped to cause or shield against death in these patients. Another expert indicated the information is important, but shouldn’t be overgeneralized.  Dr. Jules Garbus, a colorectal surgeon at Winthrop-University Hospital in Mineola, N.Y. feels that this study reinforces the fact that colorectal cancer treatment needs to be individualized for each patient and practitioners must exercise caution when discussing any “benefits” of being overweight with patients because there is stronger data to support the dangers of obesity on overall health and well-being.

-Dr Fredda Branyon

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apple

Apples are a Perfect Pick

We have all heard about how good apples are for you. As I write this article, I would like to caution any of the cancer patients about over eating apples. Our patients at New Hope Unlimited are cautioned not eat them during treatment. My reasoning for this is simple. There are a lot of studies about how wonderful apples are to keep you healthy but there is none available to prove that apples can help treat cancer. So, to try to stay healthy is great, but if you already have been diagnosed with cancer, be careful.

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When you peel an apple and let it sit for only a few seconds to minutes, what happens? The high starch content turns the apple brown. Starch turns into a certain form of glucose sugar. Science has proven 100 percent that cancer feeds off of sugar. Are you willing to take the chance of feeding the cancer? If not, try some berries such as organic blue berries, strawberries, blackberries, etc. They have been proven to be great anti-cancer foods.

So now let’s discuss the good things about apples. Just how true is the old saying, “an apple a day, keeps the doctor away?”  Many cultures have valued apples for their medicinal properties for thousands of years.  Research from our modern day has confirmed many health benefits associated with apples, and there are hundreds of published papers showing why apples are a true super-fruit to keep you healthy.  

Some reasons to enjoy the benefits of apples are:

  • They are nature’s perfect snack.  It’s the perfect portion-controlled portable pick with only 115 calories and 5 grams of filling fiber.  Vitamin C is one good source, and an apple contains no fat, sodium or cholesterol.  If you leave the skin on you’ll score even more nutrition perks, as it has 2/3’s of the fiber and beneficial antioxidants. Use them in sauces, entrees and desserts.  Apple cider is great, especially when spiced with cinnamon and warmed for a cold winter night.  (And that is coming!!)
  • They might just cut your cancer risk.  Some studies are showing that apples may provide protection against certain types of cancer such as the risk for oral, esophageal, larynx, lung, colon, breast, ovary and prostate cancers.
  • Let them whittle your middle.  Having an apple or two a day and you might avoid an apple shape.  Apples contain filling soluble fiber and ursolic acid, a natural compound that has been found to boost fat-burning.
  • Boost your brain.  Apples are natural brain boosters according to researchers from Cornell University.  The nutrients in apples may protect brain neurons against oxidative damage that contributes to neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.  An apple compound called quercetin may be responsible for this protective effect.
  • They’ll help you breathe easier.  You can protect your lungs against the oxidative damage that’s associated with asthma, bronchitis and emphysema from the antioxidants.  Pregnant women eating apples during pregnancy reduced the risk of asthma and wheezing in their child at age five.
  • So grab that bag of delicious apples for your snack or dessert and skip the high calories and sugary desserts.  My favorite apple is the Macintosh from Vermont, personally picked!  Just look at all the amazing benefits you will reap from this choice to help you stay healthy!

–Dr Fredda Branyon

Pancreatic Cancer 3rd Biggest Cancer Killer In EU

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It is believed that the number of deaths from pancreatic cancer will overtake breast cancer mortality in the EU in 2017, according to a new study.  These findings were recently presented at UEG Week 2016, and mean that pancreatic cancer will become the third leading cause of death from cancer in the EU behind lung and colorectal cancer.  Mortality rates for pancreatic cancer are increasing in many countries across the EU and estimated that 91,500 deaths will occur from the disease next year, compared with 91,000 from breast cancer.

Time-linear prediction models were used by the researchers to estimate mortality rates until 2025, when deaths from pancreatic cancer (111,500) across Europe are projected to increase by almost 50% since 2010 (76,000).  The study included all countries and show varying increases in pancreatic cancer mortality rates from 20% to a staggering 131% increase over the 15-year period.

Even though being the 3rd biggest cancer killer, the incidence of pancreatic cancer across Europe is relatively low in comparison with colorectal, lung and breast cancer.  This gives an extremely poor outlook for patients that are diagnosed with the disease, and unlike other cancers, has not changed in the last 40 years. The median 5-year survival rate for pancreatic cancer across Europe shown by research is 5% and patients lose 98% of their healthy life expectancy at the point of diagnosis.  However, 64% of Europeans state they know very little about pancreatic cancer and there is currently no feasible screening method.

On November 17th at the Ahead of World Pancreatic Cancer Day, the experts called for increased awareness of the disease to allow patients to be diagnosed in time for life-saving treatment.  A UEG pancreatic cancer specialist, Profession Matthias, explains that pancreatic cancer survival rate is lower than any other cancer and it is vital that patients receive a diagnosis as early as possible to receive treatment.  He suggests that patients and doctors increase their knowledge of the signs for pancreatic cancer, which might include new onset of diabetes, abdominal and back pain, a change in bowels and jaundice.

Everyone should be active in being aware of any bodily changes.  A sudden change just might indicate something serious that needs immediate attention.

–Dr Fredda Branyon

Hyaluronic Acid May Not Be Good For Cancer

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It has be found that usually cancer drugs fail because they cannot penetrate the high-pressure environment of solid tumors. Biophysical Journal published a study that reveals large, naturally occurring molecule called hyaluronic acid is primarily responsible for generating elevated gel-fluid pressures in tumors. Treatment with an enzyme that breaks down hyaluronic acid normalized fluid pressure in tumors and allows vessels to re-expand, overcomes a major barrier to drug delivery in a mouse model of pancreatic cancer.

The gel-fluid phase generates a primary mechanism of drug resistance in pancreas cancer, according to the senior study author Sunil Hingorani of the Fred Hutchinson Cancer Research Center. This also means it may be worth revisiting some of the many agents that have previously failed in pancreas cancer patients and make sure they are first getting into tumor. Also, elevated pressures due to the gel-fluid phase might be present in many other solid types of tumors, so it might be worth seeing to what extent drug delivery can be improved in those settings, too.

The elevated fluid pressure in tumors was first described more than 60 years ago. A number of studies have measured fluid pressures in a variety of tumor models using classical methods as the wick-in-needle technique. Needles containing nylon threads are filled with a solution and connected to a pressure-measuring device. In the past these techniques measured only modestly elevated fluid pressure, which could not account for widespread vascular collapse, which is a major barrier to drug delivery.

These methods only measure freely flowing fluid and overlook the fluid that is trapped in immobile phases. Hingorani and his team suspected a large immobile-fluid phase generated by hyaluronic acid could be a principal driver of high pressures in many solid tumors. They tested this idea with an instrument called a piezoelectric pressure catheter transducer to capture both free and immobile fluid pressures in tumors.

The measurements of fluid pressure using the piezoelectric pressure catheter transducer were much higher than those by the wick-in needle technique. The findings show the hyaluronic acid-dependent immobile fluid phase plays a previously underappreciated role in driving high pressures in solid tumors.

A mouse model of pancreatic cancer with a modified form of an enzyme called hyaluronidase was used. It eliminated the immobile fluid phase and allowed vessels that had collapsed under pressure to re-expand.

A number of randomized clinical trials are examining the safety and effectiveness of hyaluronidase combination therapy in cancer patients. The National Institutes of Health National Cancer Institute, the Lustgarten Foundation and the Giles W. and Elise G. Mead Foundation supported this study. Several authors were employees, consultants and/or shareholders of Halozyme Therapeutics.

–Dr Fredda Branyon

Chemo and Alternative Medicine

At last! A study that proves complementary and alternative medicine can work.

Those women with early-stage breast cancer that had used dietary supplements and multiple types of complementary and alternative medicine (CAM), were less likely to start chemotherapy than nonusers of CAM, according to a new study that was published online by Jama Oncology.  Despite the survival benefits associated with adjutant treatment for breast cancer, not all women initiate the treatment.  The decision to use chemotherapy involves psychosocial factors, belief systems, clinical, demographic and provider characteristics.  Patients with breast cancer showed an increased use of CAMs in the past two decades, but few studies have evaluated how CAM use affects decisions regarding chemotherapy.

Coauthors and Heather Greenlee, N.D., Ph.D., of the Mailman School of Public Health at Columbia University, New York, have studied a group of 685 women with early-stage breast cancer who were recruited from multiple sites.  Their participants were younger than 70 with non-metastatic invasive breast cancer.  Five types of CAM were included as vitamins and /or minerals, herbs and/or botanicals, other natural products, mind-body self-practice and mind-body practitioner-based practice.  A CAM index summarizing the number of types of CAM was used.

There were 306 women clinically indicated to receive chemotherapy based on guidelines, and the rest of the women were considered to have a discretionary recommendation for chemotherapy.  Most of the women (272 or 89%) were by 12 months indicated for initiated treatment of chemotherapy.  The women for whom chemotherapy was discretionary had a much lower rate of initiation of 36% (135 women).

Of the 598 women participants (or 87%), they reported CAM use at baseline.  Types of common CAM that were used were dietary supplements and mind-body practices.  The average number of CAM modalities used was two and 261 women, or 38%, reported using three or more types of CAM.

The use of dietary supplements and a higher CAM index score among women for whom chemotherapy was indicated were associated with a lower likelihood to initiate chemotherapy than the nonusers.  There was no association between starting chemotherapy and CAM use among women for whom chemotherapy was discretionary.

It is noted that it is important to consider possible alternative explanations for their findings and it is unclear if the association between CAM use and chemotherapy non-initiation reflects long-standing decision-making patterns among the study participants.  Results may suggest to oncologists that it might be beneficial to ascertain CAM use among their patients, especially dietary supplement use, and to consider CAM use as a potential marker of patients at risk of not initiating clinically indicated chemotherapy.

Doesn’t it make much more sense to build the body up to its healthy potential before even considering chemotherapy that delivers poison to your body?  Remember, the decision is in the individual’s own hands.  The suggestion of chemotherapy does not have to be your first choice.

–Dr Fredda Branyon