The Americans with Disabilities Act of 1990 (ADA) is celebrating its 20th Anniversary.  You may think of this as a law that affects only the rights of people in wheelchairs, blind or deaf, or the mentally challenged.  Well, that is all true - employers can't fire disabled employees or refuse to hire people with disabilities - providing they can perform all the requirements of the job.  In 2008, the ADA law was changed so that people with cancer will enjoy equal protection of their civil rights.  Bottom line:  You can't be fired for having breast cancer.

When I was diagnosed with breast cancer in March 2002, my health insurance was provided through my employer.  I had no idea that ADA protected me from being fired, and I was worried that I would lose my job and my insurance as a result of being away from the office due to treatment side effects.  I had several surgeries and one nearly catastrophic chemo treatment that caused my blood counts to fall so low that I was hospitalized and given 3 pints of blood.  I had to remain in the hospital for three days, and it took me a month to recover - that's a long time to be away from a position of responsibility.  My boss and co-workers stayed in contact and were very supportive in countless ways.  Speaking of my boss, she was the one who informed me about my job protection under ADA.   She set me up with extra time through FMLA, the Family and Medical Leave Act.  Even if I had been laid off, I could have kept my employer's health insurance via COBRA, if I could have afforded it.

If you've been diagnosed with breast cancer, make sure you know your workplace rights.  There is strong legal protection for you, to keep your income, health insurance, and take time off when medically necessary.  If you feel good enough, you can keep working right through treatments for breast cancer and beyond.  Thanks to the Americans with Disabilities Act, you are covered.

Ginny Hunt, Pam Stephan Photo © Phyllis Clem

I get various reactions when I tell people that I write about breast cancer.  Some people actually shudder, a few are fascinated, many just quickly change the subject.  Health care professionals aside, not many people want to think about - and write about - breast cancer every day, all the time.  But this is what I do - even when I'm away from my computer and reference books, even when I'm on my summer vacation.  You see, breast cancer won't take a day off, it won't just go away and never return to haunt the Earth.

My sister has a best friend, Ginny Hunt.  She has just finished taking chemo for breast cancer, and is ready to move on to the next phase of life.  I was fortunate to visit her while staying with my sister during my vacation.  My sister Phyllis went with Ginny to every chemo and several doctor's appointments, and it was their mutual support that inspired me to write "How To Be a Chemo Support Buddy."   I couldn't be there for Ginny, but I offered support via email and phone texts and sent care packages for each infusion.  Ginny and I had never met until she had finished chemo, yet as soon as she was diagnosed, she became my sister.  Ginny is not defined by her breast cancer diagnosis.  As she gave me a tour of her home, I realized that she is an artist with beads, fabrics, threads, and paint.  Her home is filled with creations both completed and in the works.  Ginny's artistry extends to her garden full of plants, an arbor, and carefully arranged stones.  She is focused on life - not cancer.

When I was diagnosed with breast cancer, eight years ago, I sought out support and patient education.  A local community opened to me, and several connections remain strong - a sisterhood initiated by diagnosis.  I was determined to give back to my local support community, and I still do that.  But over the last four years, I've been writing about breast cancer and reaching more patients and survivors over the internet.  I have met many inspiring people - both men and women - who have dealt with breast cancer and learned how to help others.  It is for you, my readers, that I continue to work on articles and news about breast cancer.  But here's why it is so rewarding - you have taught me much about dealing with diagnosis, side effects, life during and after breast cancer.  By voicing your opinion in the Forum, and leaving comments on my blog posts, and responding to my weekly newsletters, you have enriched my life and work on this site.

I can't be at your side every day after your diagnosis, but I can offer you my support and information daily, around the clock.  I will meet with you in the Forum, Tweet at you on Twitter, and send you information as soon as I can get it together.  You are the reason I write about breast cancer - so you can become a survivor. Just let me know what support you need - if I don't have it - another reader will!

Make no mistake about it - arsenic is a naturally occurring compound that can kill.  It's been used as a wood preservative, in chemical warfare, as part of insecticides and semiconductor manufacture, and it has caused arsenic poisoning.  Arsenic trioxide has been used in treatments for acute promyelocytic leukemia (APL) and medulloblastoma, a type of brain cancer.  Now it may be used to fight a treatment-resistant kind of breast cancer - triple negative breast cancer (TNBC).

Scientists at at Northwestern University have long known that arsenic trioxide was effective against fluid cancers, but wasn't useful in fighting solid tumors like breast cancer.  When injected into the bloodstream as chemotherapy for breast cancer, arsenic trioxide would float quickly through the circulatory system without affecting a breast tumor.  To make the arsenic compound more effective, the researchers modified the drug to create a stealth weapon that would affect a triple negative breast tumor directly, without causing toxic effects to the rest of your body.

"The anti-tumor effects of the arsenic nanobins against clinically aggressive triple negative breast tumors in mice are extremely encouraging," said Vince Cryns, associate professor of medicine and an endocrinologist at Northwestern Medicine. "There's an urgent need to develop new therapies for poor prognosis triple negative breast cancer."  These arsenic nanobins are complicated anti-cancer bombs that travel through your bloodstream and attack just the cancer cells. Arsenic trioxide is hidden inside a nanoparticle called a nanobin.  Within the nanobin, the arsenic is sealed inside a vessel, which is in turn coated with a chemical that prevents it from dissolving in your bloodstream and makes it invisible to non-cancerous cells.  But when this arsenic nanobin reaches a solid breast tumor, it sheds its chemical disguise and burrows into the tumor cells.  Once inside the tumor, the arsenic does its deadly work on the cancer cells.  In a study on mice with breast cancer, this arsenic trioxide nanoparticle made tumors shrink!  Dr Cryns and Richard Ahn published their research on arsenic trioxide nanobins in Clinical Cancer Research on July 15, 2010. 

After having early-stage breast cancer, I was prescribed hormone therapy.  Many of us take Tamoxifen - an estrogen blocker, or aromatase inhibitors like Aromasin, to prevent a recurrence of breast cancer.  I took Tamoxifen for 2 years but when my oncologist was certain that my medical menopause had turned into natural menopause, he switched me over to Aromasin.  Both hormone therapies have side effects - hot flashes, joint pain, fatigue, vaginal dryness, and osteoporosis.  Those aren't pleasant, but neither were the side effects of chemo - something I would gladly avoid again!  When faced with the spectre of a possible recurrence, I thought I'd rather have 5 years of chemically-induced hot flashes than find another breast lump and face more surgery, chemo, radiation.  The trade-offs seemed like a no-brainer.  So I was surprised to read that just about half of all women who are supposed to take these therapies quit before their 5-year prescriptions expire.

Scientists in New York and California studied 8,769 early-stage breast cancer patients with estrogen-fueled tumors to see how well they stuck to their hormonal therapies after primary treatment was completed. The results of their study was published in the Journal of Clinical Oncology on June 28.  They looked at pharmacy records and refill dates for hormonal therapy prescriptions for these patients between the years of 1996 to 2007.  Most patients are prescribed 5 years of hormonal therapy.  In this study, almost all patients ordered and refilled their hormone therapies for the first year after primary treatment.  Women under 40 - the very patients with the longest life expectancy - were the ones most likely to quit taking their medication before the 5 years were over.  These accounted for about 49% of the total of all patients in this study.  Patients who were married, were treated with chemo or radiation, came from Asian families, and got their refills at 90-day intervals tended to complete their hormonal therapy.  Researchers would like to understand why younger women don't always finish their 5-year follow-up hormone therapies, because those patients should have the most success in avoiding a recurrence.

While I did finish my hormone therapy, it was a battle sometimes.  I wanted the hot flashes to stop, I wanted my bones to be healthy, and I wanted to feel more like a normal female again.  But I stuck to the pills because I felt there was still lots to live for.  I wanted to do whatever it took to continue to survive without another round of breast cancer.  The study's researchers found that in addition to avoiding the side effects of hormone therapy, women sometimes quit because they didn't really understand why they needed to take these medications, or the prescriptions cost too much, or insurance copayments got to be burdensome.  I can think of other reasons that a woman under 40 would skip these pills:  estrogen blockers can reduce fertility, lower libido, cause endometrical thickening, and contribute to the formation of cataracts.  Even though none of those conditions is as bad as having breast cancer, what many patients really want is to get their life back after breast cancer - they don't want a daily pill to be remind them that cancer may lurk in their future.

After primary treatment, breast cancer patients will visit their oncologists at regular intervals over that 5-year period when they are supposed to be taking their hormonal therapy.  During those visits, the doctor will check for signs of recurrence, take vital signs, and do bloodwork.  Perhaps they should also be asking if patients are taking their hormone pills.  "Physicians are often unaware of patient compliance, and this is becoming an increasingly important issue in cancer," said the study's leader, Dr. Dawn Hershman.  While oncologists are doing all they can to help patients avoid a recurrence, it really is up to each of us to guard our own health. If the cost of hormone therapy or the side effects is getting you down before your 5 years are up, ask for help getting the medications or coping with the side effects.  Your future health is well worth taking those little pills.  Hormone therapy isn't magic and sure isn't a guarantee, but since it should protect you - please finish your therapy.  You could save your own life.

Cast Your Vote: Reason you would stop taking hormone therapy