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A Wake-Up Call for Women

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March 14, 2024—Actress Olivia Munn’s candid disclosures on Instagram about her aggressive breast cancer — a surprise discovery after a “clean” mammogram and negative genetic tests — were a poignant mix of details about her cancer journey and a cautionary tale for women.  

Munn earlier this week revealed her 10-month battle with breast cancer, which resulted in four surgeries and a double mastectomy, and used the social media site as a way of encouraging women to educate themselves about the disease and the importance of appropriate screening tests.

Munn’s experience reveals some truths that women may not know: Most women who get breast cancer don’t have a genetic predisposition. Mammograms don’t detect all cancers. An individual risk assessment — which Munn’s OB/GYN doctor recommended — can point to the need for additional testing to find tumors mammograms have missed.

Munn, 43, known for her work on The Daily Show with Jon Stewart, as economist Sloan Sabbith on the HBO political drama The Newsroom, and movies including Magic Mike, wrote in detail on Instagram about finding out she had an aggressive form of cancer known as luminal B despite having a normal mammogram and testing negative on a genetic test that she said checked for 90 different cancer genes. 

Her doctor did an individual risk assessment, finding Munn’s lifetime risk was 37%, considered very high, and referred her to more extensive testing, which detected cancer in both breasts.

Munn said in a series of Instagram posts that she initially kept her diagnosis private, explaining, “I needed to catch my breath and get through some of the hardest parts before sharing.” She lauds her OB/GYN, Thais Aliabadi, MD, who decided to calculate the risk score. “The fact that she did saved my life,” Munn wrote. 

Munn’s fighting spirit and positive attitude are apparent. “I’m lucky,” she posted. “We caught it with enough time that I had options.” She praised the efforts of John Mulaney, her partner with whom she shares a 2-year-old son. He researched treatments and medication and posted pictures bedside of their son.

Munn thanked her doctors and other staff at Cedars-Sinai Medical Center in Los Angeles and Providence Saint John’s Health Center in Santa Monica, including her surgical oncologist, Armando Giuliano, MD, her reconstructive surgeon, Jay Orringer, MD, her oncologist, Monica Mita, MD, and Aliabadi.

A spokeswoman for Munn said the actress is not doing interviews at this time. Spokespersons at Cedars-Sinai declined to comment on Munn’s case.

Genetics and Breast Cancer 

“Most people who get breast cancer don’t have an inherited genetic mutation,” said Nathalie Johnson, MD, medical director of the Legacy Health Systems Cancer Institute and the Legacy Breast Health Centers in Portland, OR, who was not involved in Munn’s treatment. 

“Only 5 to 10% of people who get breast cancer have a gene that tests positive,” agreed Joanne Mortimer, MD, director of Women’s Cancers Program and a medical oncologist at City of Hope in Duarte, CA. Mortimer was also not involved in Munn’s care and spoke generally about breast cancer treatment in cases similar to Munn’s.

Cancer Subtypes

Luminal breast cancers are those originating inthe luminal or inner lining of the mammary ducts. Both luminal A and luminal B need estrogen to grow, Johnson said. Luminal A has a better prognosis and is easier to treat. Luminal B has a worse prognosis, she said, and it’s sometimes dubbed B for “bad.” 

Luminal B “requires chemotherapy and if it recurs; it’s just harder. It stops responding to endocrine therapy or estrogen-blocking drugs and so we have to use other therapies.” 

Genomic testing helps doctors decide if the luminal tumors are A or B forms, she said. The prognosis for luminal B cancers can still be good, Johnson said.

Beyond Mammograms

“Mammograms aren’t perfect,” Johnson said. The screening can especially miss cancers in breasts with dense tissue because the cancers don’t show up as well on the imaging. 

Density refers to the amount of fibrous and glandular tissues in the breast compared to fatty tissue. About half of women age 40 and above have dense breasts, according to the CDC. The mammogram report may include information about whether breast density is high or low. 

If breasts are dense, an ultrasound or breast MRI would be good supplementary tests, Johnson said.

Even though mammograms miss some cancers, Johnson urges women to undergo the exams as recommended. The U.S. Preventive Services Task Force, in its draft recommendation, calls for mammograms beginning at age 40 and repeated every other year.

Even if mammogram results show no evidence of cancer, if a woman feels something unusual in her breasts, it’s time to return to the doctor and ask about further testing, Johnson said.

An MRI is often done in women as young as Munn, Mortimer said, if they are known to have dense breasts or a family history, both known to raise breast cancer risk. “In someone with a family history, we alternate MRIs with mammograms to increase the chances of detection,” she said.

Individual Assessments

In her Instagram posts, Munn praises her OB/GYN for suggesting an individual risk assessment. “Dr. [Thais] Aliabadi looked at factors like my age, familial breast cancer history, and the fact that I had my first child after the age of 30,” Munn wrote on Instagram. “She discovered my lifetime risk was at 37%.” 

That score prompted the doctor to refer Munn for an MRI and then an ultrasound and biopsy. “The biopsy showed I had Luminal B cancer in both breasts,” Munn wrote. “Luminal B is an aggressive, fast-moving cancer.” Thirty days later, Munn had a double mastectomy.

One such risk assessment is on the National Cancer Institute site. It takes into account a history of breast cancer, previous radiation to the chest, genetic mutations, age, race, ethnicity, history of a breast biopsy with a benign diagnosis, age at first menstrual period, age when first child was born (over 30 raises risk), and first-degree relatives (your parents, sibling, or child) with breast cancer.

From that, it predicts a 5-year risk and a lifetime risk of developing breast cancer, comparing the patient’s risk with the average risk of the population.

For instance, a 43-year-old White woman with no history of breast cancer or previous radiation, no genetic mutations, no previous breast biopsies, first period at age 12, 30 or older at first childbirth, and no first-degree relatives with breast cancer has a 13.2% lifetime risk of breast cancer, slightly above the average risk of 12.1%.

Treatment Options

Besides the type of tumor detected, factors such as lymph node involvement drive treatment decisions, Johnson and Mortimer said. 

For a young woman with luminal B breast cancer, the usual regimen would be surgery, chemotherapy, and estrogen-blocking therapy. “The luminal B prognosis is still good if you do the chemo as well as the endocrine therapy.” Johnson said.

Models can assess survival rates if the treatment includes chemotherapy or does not, Johnson said, helping women to make their own decisions.

Mortimer called Munn’s OB/GYN “pretty amazing” to suggest the risk calculator and take action, finding the tumor much earlier than the next scheduled mammogram would have.



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The Truth About Whole-Body Scans

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Take a drive around certain neighborhoods in Los Angeles and you may spot as many signs advertising body scans as burger joints. Or maybe you’ve seen the ads on TV or the internet: “Protect your health! Get a body scan now!” 

Are whole-body CT scans really able to do that – and what are the risks? And are DEXA scans a good way to check on your body composition?

While technologies vary, most of these high-tech checkups use computed tomography (CT) scans to examine your entire body or specific parts, such as the heart and lungs, to try to catch dangerous diseases in earlier, more curable stages.

During the 15- or 20-minute scan, you lie inside a doughnut-shaped machine as an imaging device rotates around you, transmitting radiation. The technique combines multiple X-ray images and, with the aid of a computer, produces cross-sectional views of your body. By examining the views, a doctor can look for early signs of abnormalities.

The scans aren’t cheap – whole-body scans run anywhere from $500 to $1,000 per scan and usually aren’t reimbursed by insurance. And the question of how helpful these scans really are is a matter of debate among medical experts.

Advocates promote scans as a smart part of a routine physical exam. But if you’re healthy, with no worrisome symptoms, a scan is usually not warranted, says Arl Van Moore, MD, a radiologist and clinical assistant professor of radiology at Duke University Medical Center in Durham, NC, who is also a spokesman for the American College of Radiology (ACR).

According to the ACR’s official position, there’s not enough evidence to recommend scans for those with no symptoms or family history suggesting disease. But Van Moore sees a possible exception. “There may be a benefit to people at high risk of lung cancers, such as current smokers or those with a long history of smoking,” he says. 

For healthy people, the scans may cause undue worry – for instance, by finding something that turns out to be benign. Plus, the amount of radiation exposure, especially with frequent scans, is another concern. If scans are done too often, the radiation exposure may actually increase the number of cancer cases over the long term, according to a 2004 report in the journal Radiology.

The American College of Preventive Medicine says that whole-body scans “aren’t very good at finding cancer in people without symptoms” and that the radiation you get from these scans can increase your risk of cancer.

Before scheduling a body scan, talk to your doctor about your overall health risks and how a scan may or may not help you. In particular, ask yourself:

  • What’s your history? Do you have a personal or family history of lung disease, heart disease, or specific cancers?
  • Did you inhale? Are you a longtime smoker?
  • If so, how long? Even if you’ve quit smoking, for how many years were you an active smoker?

 

This is a different type of scan, called DEXA (dual energy X-ray absorptiometry). You might have heard of DEXA scans to check on bone density to see if you have osteoporosis or osteopenia. It uses low-level X-rays to check on your body composition, like how much body fat you have and where it is in your body. 

There are various ways to measure your body fat. Experts have told WebMD in the past that DEXA scanning is a “very good technique” and “one of the most accurate methods out there.” And researchers have called it the “gold standard” for checking on body composition – specifically, for bone, fat, and muscle. But it’s not covered by insurance, unless you’re getting a DEXA scan to screen for bone density. The cost of a DEXA scan varies, starting around $75 in some cases.

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5 Family and Community Engagement Strategies to Improve Student Outcomes

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Strong school-family-community partnerships bring exceptional value to children’s education. A recent book by Karen L. Mapp, a senior lecturer at the Harvard Graduate School of Education, and four other co-collaborators synthesizes the available research to explain who benefits from these partnerships and the many advantages of family and community engagement.

Everyone Wins! The Evidence for Family-School Partnerships & Implications for Practice (Scholastic, 2022) cites various research to demonstrate how family-community-school partnerships benefit all stakeholder groups when they’re approached effectively:

  • Students have higher grades, better attendance, deeper engagement in school, greater self-esteem, and higher rates of graduation and college attainment.
  • Educators enjoy better job satisfaction, better success motivating students from different backgrounds, more family support, and an improved mindset about students and their families.
  • Families have stronger relationships with their children and better rapport with educators. They can navigate school policies and advocate for their children more effectively.
  • Schools enjoy a better climate, more support from their community, and improved staff morale—leading to better teacher retention.
  • School districts and communities become better places to live and raise children. They experience fewer disciplinary problems, greater participation in afterschool programs, and more family and student involvement in decision-making.
community members talking and hugging in matching green volunteer t-shirts in front of an outdoor mural

What elements make school-family-community partnerships particularly effective? Here are five tips for how school systems can successfully promote family and community engagement in education and drive better student outcomes.

1. Successful Family Engagement Requires Intentional Leadership

Engaging with families has to be a core activity and not just an afterthought. It requires a total commitment by school and district leaders, and this commitment must include investing in the tools and training needed to help educators effectively engage with families from all backgrounds. It must be a real and intentional focus, and as Mapp says: “It’s real when I see it on your budget sheets.”

2. Teachers and Administrators Must Communicate Clearly and Consistently

To encourage family involvement in their children’s education, educators must interact with families frequently—and in many ways. For instance, teachers and administrators might engage with families in person during school drop-off and pick-up periods, set up a Family Information Board in the school’s lobby, write and distribute regular newsletters or blog posts, and/or send emails or text messages to parents.

Communicating effectively is one of the National PTA’s “National Standards for Family-School Partnerships,” which guides how schools and families should work together to support student success. Teachers and administrators should learn about and meet families’ preferred methods of communication, and families should be able to share and receive information in culturally and linguistically relevant ways.

3. Develop Healthy, Positive Relationships Based on Mutual Trust and Respect

Interactions between educators and families should be positive and reciprocal, with families feeling valued and supported. Educators can establish trust and encourage healthy, two-way communications with families by sharing information about their children’s positive behaviors and accomplishments and which skills may need work. Listen to all parents and provide opportunities for shared decision-making.

4. Be Mindful of Diversity, Equity, and Inclusion

Welcoming all families and fostering a sense of belonging is another National PTA standard. When families engage with your school, do they feel respected, understood, and connected to the school community?

To ensure equity and inclusion, learn about the families you serve and their unique needs and challenges. Use culturally responsive engagement practices. Create opportunities for connection, especially with historically marginalized families and students. Learn about and seek to remove barriers for families to participate fully in their children’s education.

5. Help Families Support and Extend the Learning at Home

Students learn more effectively when they have opportunities at home to practice, reinforce, or extend the skills and lessons they’ve learned in school. Educators can facilitate this process by giving families specific ideas for expanding their children’s learning at home, such as by incorporating core math and literacy concepts into everyday routines.

Schools can also make instructional resources such as take-home packs, activity sets, and other materials available to families to support their children’s education.

How School Specialty® Can Help

School Specialty has more than six decades of experience in providing tools, resources, and strategies that promote successful education both in school and at home. We offer arts and crafts, early childhood, ELA, math, science, STEM/STEAM, physical education, special needs, and social emotional learning resources for families, as well as games, puzzles, and general supplies.

How do you promote family engagement in your classroom and community? Let us know in the comments!



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Preteens and skincare: What parents should know – CHOC

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Published on: April 16, 2024
Last updated: April 9, 2024

Should teens and preteens be using so many skincare products with fancy ingredients? A pediatric dermatologist answers parents’ questions.

Link: https://health.choc.org/preteens-and-skincare-what-parents-should-know/

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