Genome Project ties some forms of TNBC to ovarian cancer

Basal-like breast cancers, many of which are triple-negative,  bear a molecular similarity to ovarian cancers, which can ultimately lead us to targeted therapies, according to researchers at The Cancer Genome Atlas program in research published in the September 23, 2012 online edition of the journal Nature.  And it's possible that this could eventually lead to less-toxic chemotherapy treatments.

Charles Perou, PhD, corresponding author of the paper, says, "Through the use of multiple different technologies, we were able to collect the most complete picture of breast cancer diversity ever. These studies have important implications for all breast cancer patients and confirm a large number of our previous findings. In particular, we now have a much better picture of the genetic causes of the most common form of breast cancer, namely estrogen-receptor positive/Luminal A disease. We also found a stunning similarity between basal-like breast cancers and ovarian cancers."

[NOTE:  Some news stories I have read equate TNBC with basal-like tumors, which is not accurate.  There is a correlation between TNBC and basal-like cancers, but not all TNBC tumors are basal-like, and not all basal-like tumors are TNBC.  In fact, some researchers break TNBC into three subtypes, including basal-like and non-basal-like.  And, of course, some outlets, such as The New York Times, use terms such as "particularly deadly," for TNBC, when the fact remains that most women survive it.]

According to the genome research, basal-like breast tumors share molecular similarities with high-grade ovarian tumors, meaning the likelihood of a related origin and similar therapeutic opportunities. Interestingly, basal-like breast cancer was more similar to ovarian cancer than to ER-positive breast cancer.

Matthew Ellis of the Washington University School of Medicine in St. Louis offered on intriguing possibility:  that women with TNBC might do better on the standard chemotherapy regimen for ovarian cancer, which is less toxic.  He suggests clinical trials using these drugs,  which typically combine a platinum-based agent such as carboplatin (Paraplatin) or cisplatin with a taxane such as paclitaxel (Taxol) or docetaxel (Taxotere). Currently, breast cancer patients are treated with the more toxic anthracyclines, such as Adriamycin and Epirubicin. 

Katherine Hoadley, PhD, study co-author, says that basal-like breast cancer should be studied as distinct from other breast cancers: "Our ability to compare and integrate data from RNA, microRNA, mutations, protein, DNA methylation, and DNA copy number gave us a multitude of insights about breast cancer. In particular, highlighting how distinct basal-like breast cancers are from all other breast cancers on all data types. These findings suggest that basal-like breast cancer, while arising in the same anatomical location, is potentially a completely different disease."

MD Anderson Focuses on Eradicating Cancer, Including Attacks on TNBC

NEWS RELEASE

The University of Texas MD Anderson Cancer Center announces the launch of theMoon Shots Program, an unprecedented effort to dramatically accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths.

Even as the number of cancer survivors in the US is expected to reach an estimated 11.3 million by 2015, according to the American Cancer Society, cancer remains one of the most destructive and vexing diseases. An estimated 100 million people worldwide are expected to lose their lives to cancer in this decade alone. The disease's devastation to humanity now exceeds that of cardiovascular disease, tuberculosis, HIV and malaria - combined.

The Moon Shots Program is built upon a "disruptive paradigm" that brings together the best attributes of both academia and industry by creating cross-functional professional teams working in a goal-oriented, milestone-driven manner to convert knowledge into tests, devices, drugs and policies that can benefit patients as quickly as possible.

The Moon Shots Program takes its inspiration from President John Kennedy's famous 1962 speech, made 50 years ago this month at Rice University, just a mile from the main MD Anderson campus. "We choose to go to the moon in this decade ... because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win," Kennedy said.

"Generations later, the Moon Shots Program signals our confidence that the path to curing cancer is in clearer sight than at any other time in history," said Ronald A. DePinho, M.D., MD Anderson's president. "Humanity urgently needs bold action to defeat cancer. I believe that we have many of the tools we need to pick the fight of the 21st century. Let's focus our energies on approaching cancer comprehensively and systematically, with the precision of an engineer, always asking ... 'What can we do to directly impact patients?'"

The inaugural moon shots
The program, initially targeting eight cancers, will bring together sizable multidisciplinary groups of MD Anderson researchers and clinicians to mount comprehensive attacks on:

• acute myeloid leukemia/myelodysplastic syndrome;
• chronic lymphocytic leukemia;
• melanoma;
• lung cancer;
• prostate cancer, and
• triple-negative breast and ovarian cancers - two cancers linked at the molecular level.

Six moon shot teams, representing these eight cancers, were selected based on rigorous criteria that assess not only the current state of scientific knowledge of the disease across the entire cancer care continuum from prevention to survivorship, but also the strength and breadth of the assembled teams and the potential for near-term measurable success in terms of cancer mortality.

Each moon shot will receive an infusion of funds and other resources needed to work on ambitious and innovative projects prioritized for patient impact, ranging from basic and translational research to biomarker-driven novel clinical trials, to behavioral interventions and public policy initiatives.

The platforms make the program uniqueThe institution-wide, high quality scientific and technical platforms will provide key infrastructure for the success of the Moon Shots Program. In the past, each investigator or group of investigators has developed their own infrastructure to support their research programs. Frequently they were under-funded and lacked the high level management and leadership required to ensure that they were of the highest caliber and in particular that they were able to adapt to the rapidly changing scientific and technological environment. The moon shot platforms will be designed and resourced to provide expertise that will support the efforts of all of moon shots teams. The platforms will provide a critical component to the success of each moon shot and of the overall Moon Shots Program. In particular, they will leverage the investment across the moon shots.

These platforms include:

• Adaptive Learning in Genomic Medicine: A work flow that enables clinicians and researchers to integrate real-time patient clinical information and research genomic data, allowing understanding of the cancer genome and ultimately improving outcome.
• Big Data: The capture, storage and processing of huge amounts of information, much of it coming from Next Generation Sequencing machines (genome sequencing).
• Cancer Control and Prevention: Community-based efforts in cancer prevention, screening, and early detection and survivorship to educate and achieve a measureable reduction in the cancer burden. Interventions in the areas of public policy, public education, professional education and evidence-based service delivery can make a measurable and lasting difference in our community, especially among those most vulnerable - the underserved.
• Center for Co-Clinical Trials: Uses mouse or cell models of human cancers to test new drugs or drug combinations and discover the subset of patients most likely to respond to the therapy.
• Clinical Genomics: An infrastructure designed to bank and process tumor specimens for clinical tests that can guide medical decisions.
• Diagnostics Development: The development of diagnostic tests for use in the clinic to guide targeted therapy.
• Early Detection: Using imaging and proteomic technologies to discover markers that can identify patients with early-staged cancers.
• Institute for Applied Cancer Science: Developing effective targeted cancer drugs.
• Institute for Personalized Cancer Therapy: An extensive infrastructure that analyzes genomic abnormalities in patient tumors to direct them to the best treatments and clinical trials.
• Massive Data Analytics: A computer infrastructure that develops or uses computational algorithms to analyze large-scale patient and public data.
• Patient Omics: Centralizing collection of patient biospecimens (tumor samples, blood, etc.) to profile genes and proteins (genomics, proteomics) and identify mutations that can guide personalized treatment decisions and predict therapy-related toxicity to improve overall patient outcomes.
• Translational Research Continuum: A framework to facilitate efficient transition of a candidate drug from preclinical studies to early stages of human clinical trial testing so effective drugs can be developed in a shorter time and clinical trials can be quicker and cheaper with higher success rates.

MD Anderson's "Giant leap for mankind"A year ago, when DePinho was named MD Anderson's fourth president, he proposed the notion of a moon shot moment. "How can we envision what's possible to reduce cancer mortality if we think boldly, adopt a more goal-oriented mentality, ignore the usual strictures on resources that encumber academic research and use the breakthrough technology available today?" he asked.

Response from the faculty and staff took the form of initial moon shot proposals that targeted several major cancer types and involved large, integrated MD Anderson teams, sometimes numbering in the hundreds.

Frank McCormick, Ph.D., director of the University of California, San Francisco Cancer Center and president of the American Association for Cancer Research, led the review panel of 25 internal and external experts that narrowed the field to the inaugural six moon shots.

"Nothing on the magnitude of the Moon Shots Program has been attempted by a single academic medical institution," McCormick said. "Moon shots take MD Anderson's deep bench of multidisciplinary research and patient care resources and offer a collective vision on moving cancer research forward."

McCormick added, "The process of bringing this amount of horsepower together in such a focused manner is not normally seen in academic medicine and is valuable in and of itself."

Most ambitious program MD Anderson has ever mountedThe Moon Shots Program is among the most formidable endeavors mounted to date by MD Anderson, an institution ranked the No. 1 hospital for cancer care byUS News & World Report's Best Hospitals survey for nine of the past 11 years, including 2012. As the program unfolds and grows, it will be woven into all areas of the institution. Researchers and clinicians concentrating on any cancer - not just the first set of moon shots - will link to new technological capabilities, data and clinical strategies afforded by the platforms.

In the first 10 years, the cost of the Moon Shots Program may reach an estimated $3 billion. Those funds will come from institutional earnings, philanthropy, competitive research grants and commercialization of new discoveries. They will not interrupt MD Anderson's vast research program in all cancers, with a budget of approximately $700 million annually. In fact, the program's efforts will help support all other cancer research at MD Anderson, particularly with improved resources and infrastructure, as the ultimate goal is to apply knowledge gained from this process to all cancers.

Implementation of the program will begin in February 2013, and is expected to reach full stride by mid-2013.

"The Moon Shots Program holds the potential for a new approach to research that eventually can be applied to all cancers and even to other chronic diseases," DePinho said. "History has taught us that if we put our minds to a task, the human spirit will prevail. We must do this - humanity is depending on all of us."

For more information, including backgrounders on the inaugural moon shots, please visit www.cancermoonshots.org.  

Tumor Suppressor Gene Surrounding TNBC Tumors Could Help Prevent Metasteses

News Release from Thomas Jefferson University

A natural substance found in the surrounding tissue of a tumor may be a promising weapon to stop triple negative breast cancer from metastasizing.

A preclinical study published in PLOS ONE September 19 byThomas Jefferson University researchers found that decorin, a well-studied protein known to help halt tumor growth, induces a series of tumor suppressor genes in the surrounding tissue in triple negative breast cancer tumors to help stop metastasis.

“These findings provide a new paradigm for decorin, with great implications for curbing tumor growth by inducing new tumor suppressor genes within the tumor microenvironment, and for the discovery of novel gene signatures that could eventually help clinical assessment and prognosis,” said senior author Renato V. Iozzo, M.D., Professor of Pathology, Anatomy and Cell Biology, at Thomas Jefferson University.

Triple negative breast cancer is the most deadly of breast cancers, [PAT'S NOTE:  AURGUHHHHHH.  TINBC can be aggressive, but is not always so.  And I would question if it is THE most deadly.  Besides, are we in competition here?] with fast-growing tumors, that disproportionately affect younger and African-American women. Today, no such marker is applied in care of triple negative breast cancer, and as a result, patients are all treated the same.

“Originally, we thought that decorin was affecting the tumor, but, surprisingly, decorin affects the so-called tumor microenvironment, where malignant cells grow and invade, igniting genes to stop such growth,” said Dr. Iozzo, who is also a member of Jefferson’s Kimmel Cancer Center. “Absence of decorin in the microenvironment could explain metastasis in some patients, where higher levels of the protein may keep cancer from spreading.”

In the study, 357 genes were found to be induced by the increased presence of decorin, but more interestingly, the researchers discovered that three of these genes, which were previously unlinked to triple negative breast cancer, were tumor suppressor genes affecting the tumor microenvironment, including Bmp2K, Zc3hav1, and PEG3.

Decorin is a naturally occurring substance in the connective tissue where, among other roles, it helps regulate cell growth by interacting with growth factors and collagen. A decade ago, Dr. Iozzo and his team discovered that decorin, a cell protein, and specifically, a proteoglycan, is increased in the matrix surrounding tumor cells. They also discovered that decorin causes production of a protein, p21, which also can arrest cell growth. However, decorin’s role in breast cancer and the mechanism behind its anti-tumor properties remained elusive.

For this study, researchers aimed to investigate the impact of decorin in triple negative breast cancer tumors using human cell lines in mice, as well analyze gene expression activity in the tumor microenvironment.

Tumors treated with decorin were found to have a decreased volume of up to 50 percent after 23 days. Using a sophisticated microarray technique, the researchers then analyzed the mouse tumor microenvironment, finding increased expression of 357 genes, three of which are the tumor suppressor genes of interest.

These results demonstrate a novel role for decorin in reduction or prevention of tumor metastases that could eventually lead to improved therapeutics for metastatic breast cancer.

“Here, we have a molecule that can turn a tumor microenvironment from a bad neighborhood to a clean neighborhood by inducing genes in that neighborhood to stop growth and prevent the tumor from metastasizing,” said Dr. Iozzo.

##

This work was in part supported by the National Institutes of Health grants RO1CA39481, RO1CA47282 and RO1CA120975.

Sharing More Good News: Healthy Two Years After TNBC Recurrence

An inspiring note from one of my readers, who posted it in the comments section of a previous post:

After a recurrence I was told "the TN will probably come back within 3 months."  That was 2 years ago. The doctors are surprised to say the least. But I know why at least in part I am in great health. Exercise, a very very good diet, green drink, structured relaxation most days, and herbs from the Block Center [This refers to the Block Center for Integrated Cancer Treatment] are some of the reasons. 

But also working on my spirit and doing the things I truly love. That has meant finding the strength to change what I do and who I am with each day. What an adventure! 

Thank you, Penny! 

Like Pat's perspective?  Check out her book, Surviving Triple-Negative Breast Cancer.  

Dancing with the Bald

Taking dancing lessons was one of the best things my husband and I have ever done.  We signed up for a course through adult education at the local middle school.  It was just us and about 100 other folks of about every age, all longing to make it on Dancing with The Stars.  Or to be able to actually dance at a wedding.  Some, like us, just were doing it for fun.

The first dance we learned was swing.  One, two, three, four. Twirl. One, two, duck, turn.  Or something like that.  By now, it has become second nature and I am not sure how we even do it; we both just move into step by rote. We learned to an old favorite of mine, “Bad, Bad Leroy Brown,” by Jim Croce, and whenever we hear that song, we must dance. If I’m at my desk writing and Joe is in the kitchen cooking and we hear our song, we get up, do a little four-step, giggle, kiss, and then go back to whatever we were doing.  Or not.

Me and Joe.  See how happy dancing makes us?

We search out dances—often held by charitable groups, community organizations, and clubs, at old school houses, gambling casinos, bars, churches, whatever.   It’s fun and a great way to meet new people and forget your troubles. When we’re gliding around the floor to Satin Doll, or spinning to Take Five, life just seems a little simpler and calmer.

We watch dancers in their 80s and 90s kick up their heels—and how can you not be inspired by that?

Joe and I danced all through my treatment, sometimes slowly and carefully, but we danced nevertheless.  And most people did not know I was bald beneath my fashionable wig, but I often worried that Joe’s arm would graze my head as I twirled and the wig would go flying into somebody’s Corona.  Fortunately for me and the drinkers near the dance floor, that never happened.

If you’re a 150-pound person, you’ll burn roughly 375 calories per hours with the swing and 204 with the waltz.  If you weight more, you’ll work off more.  And I guarantee you’ll work off immeasurable stress and worry.

Cancer Survivorship on the Rise

In early 2012, there were 13.7 million of us in the United States.  By us, I naturally mean cancer survivors.  Within ten years, that number will rise to 18 million or so, according to a report, sponsored by the American Cancer Society and the National Cancer Institute and published online in CA: A Cancer Journal for Clinicians (2012).

Why are there so many of us?  Partly, it’s because we’re living longer, and the longer you live, the more chance you’ll get cancer.  (Some reward for a long life, huh?)  It’s also because treatments are improving, so more of us are beating cancer. (There’s your reward.)

But, according to the report, survivors are a worried lot, expressing concern about recurrence, second cancers, and late treatment complications without cancer recurrence.

The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) program, the National Center for Health Statistics, and the University of California Berkeley's mortalitycohort life tables. Population projections were based on U.S. Census Bureaudata.

The findings, from the report:

• 6.4 million men and 7.3 million women who had been diagnosed with cancer at some point in their life were alive on Jan. 1, 2012.

• The top cancer for men was prostate, with 43 percent of the total, meaning nearly 2.8 million survivors.  

• Breast cancer was the leading cancer for women, with 41 percent of the total, and nearly 2.9 million survivors.  

• No other cancer contributed to more than 9 percent of the total in either sex. 

• In 2012, 8 percent of the women, or 606,910, had survived uterine cancer, second only to breast cancer. 

•In 2012, lung and bronchial cancer accounted for only about 3 percent of cancer survivors in both sexes, putting it eighth on the list.
•45 percent of all cancer survivors are 70 or older.

 .

---

SOURCE:  Siegel R, et al "Cancer treatment and survivorship statistics 2012" CACancer J Clin 2012;DOI:10.3322/caac.21149.

Be Part of My Presentation through the TNBC Foundation

I am honored to be the first presenter in the Triple-Negative Breast Cancer Foundation's (Un)Common Knowledge series.  My Webinar will air October 16, 2012, at 1 pm.  You can be part of the discussion by asking questions that will form the base of my presentation.  The Foundation is accepting those questions through September 24.   The details:

Please email questions to knowledge@tnbcfoundation.org. Questions that are succinct, and apply to more than one individual have a better chance of being included, as it may not be possible to address every question.

AACR Report Highlights TNBC

NEWS RELEASE

Washington, DC, September 12, 2012– The Triple Negative Breast Cancer Foundation® is proud to support the American Association for Cancer Research in their effort to raise awareness of the need for greater federal investment in the war against cancer. Representatives from the TNBCF and scores of other patient advocacy groups attended the unveiling of the AACR Cancer Progress Report 2012 here today.  [PAT'S NOTE:  You can download the report here.  Information about triple negative breast cancer from the patient's perspective is on page 40 and 68-69; other TNBC information can be found on page 17.]

“Private foundations like ours do a lot, but a strong federal commitment to breast cancer research is crucial to find breakthrough therapies for patients,” said Lori Redmer, Executive Director, Triple Negative Breast Cancer Foundation. “Besides policy and regulation, an important form of commitment is federal investment in research, and looming reductions are of grave concern to the more than 25,000 women in the US that will be diagnosed with triple negative breast cancer this year.”

Today’s report calls for legislation that provides alternative means for reducing our deficit while still protecting federal cancer research funds. This will require a concerted effort from the cancer research and advocacy community to urge legislators to work together to prevent sequestration of funds, resulting in reductions.

Over the coming months, TNBCF will be alerting its community about the situation, the risks to cancer research presented by budgetary sequestration, while urging its community to contact legislators encouraging them to find alternatives to cutting cancer research budgets.

Triple Negative Breast Cancer Foundation will also be attending a number of satellite events after the AACR Progress Report launch press conference, including an awards reception on Capitol Hill and a dinner for the honorees. TNBCF joins with the AACR in saluting those lawmakers who make cancer research funding a priority.

Triple negative breast cancer accounts for about 15% percent of all breast cancers, and is often more aggressive than other forms of the disease, while also disproportionately striking some populations such as women under 40, African Americans and Latinas. Unlike other breast cancers, triple negative breast cancers lack three specific proteins, or receptors, and as a result generally do not respond to existing targeted medicines commonly used to treat the disease. Since no targeted treatment exists yet, women with triple negative breast cancer usually receive surgery, chemotherapy or radiation. Treatment options remain limited if these interventions are not effective. Triple Negative Breast Cancer Foundation is focused solely on this dangerous form of breast cancer and is investing in research to find a targeted therapy.

About Triple Negative Breast Cancer Foundation
The Triple Negative Breast Cancer Foundation was founded in 2006 in honor of Nancy Block- Zenna, a young woman who was diagnosed at age 35 with triple-negative breast cancer and died two and a half years later in 2007. In response to Nancy's diagnosis, her close friends launched the Foundation. Our mission is to raise awareness of triple-negative breast cancer and to support scientists and researchers in their effort to determine the definitive causes of triple- negative breast cancer, so that effective detection, diagnosis, prevention and treatment can be pursued and achieved. For more information about TNBCF, visit www.tnbcfoundation.org.

About the American Association for Cancer Research
Founded in 1907, the American Association for Cancer Research (AACR) is the world’s first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR’s membership includes 34,000 laboratory, translational and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 17,000 attendees. In addition, the AACR publishes seven peer-reviewed scientific journals and a magazine for cancer survivors, patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the Scientific Partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration and scientific oversight of individual and team science grants in cancer research that have the potential for near-term patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer. For more information about the AACR, visit www.AACR.org. 

Help the TNBC Foundation

 

The Triple Negative Breast Cancer Foundation has the chance to win a share of $5,000,000 from Chase Community Giving.  Help by voting before Sept 19.  Chase customers get bonus points by checking in with your online credentials.  And you can add votes by getting folks to click your Tweets. (Such a silly phrase, isn't it?  Click your tweets.)  Vote here.  There is so much good the Foundation could do with this funding.

Clear Margins Especially Essential for TNBC

Patients with triple-negative breast cancer face an increased risk of residual cancer after a lumpectomy, making the need for generous margins especially important, according to research published in the Journal of the Academy of Physician Assistants.  Some details:
• Surgical specimens from 369 women with invasive breast cancer were examined.
• 51 percent of those with TNBC had invasive cancer in their surgical specimens.
• 30 percent of those with non-TNBC had invasive cancer in their surgical specimens,
• This means that clear margins are especially essential for those with TNBC.   Patients without clear margins might need re-excisions.

Remember: This is one study, of only 369 women.  In it, the odds of residual disease are high for all those studied—those with TNBC and those with non-TNBC.  Yet most women typically survive at far higher odds than in this study.  One reason for this may be that these specimens were taken before chemotherapy and radiation, which kill residual disease.

The bottom line: Clear margins are essential.

Additional Note:  A new device might help determine the existence of cancer on surgical margins.  In a paper  presented at the  2012  American Society of Clinical Oncology Breast Cancer Symposium in San Francisco, researchers demonstrated that the MarginProbe device found positive margins and reduced the need to re-exisions in a large, prospective trial.  Check out the article on Cancer Network.

Breasts and the Earth

Two mountains rise from the plains near Walsenburg, Colorado, twin peaks that point up to the sky like giant breasts. Native Americans —the Utes, Comanches, and Apache that once called this area home—named the peaks Wahatoya, which means Breasts of the Earth.  The Europeans who settled the region were less poetic and less graphic and called them the Spanish Peaks, and that is their official name now, the easternmost peak being, logically, the East Spanish Peak and the western one the West Spanish Peak. 

Native Americans believed that the peaks protected those who lived in their shadow. Of course, that didn’t quite work out—people still got sick, died, fought, lost money, had their hearts broken, and faced the same hardships and pain as those in less blessed areas.

We have a summer cabin in the shadow of the East Spanish Peak, so when I got breast cancer, I especially grumbled at this healthy myth.  No health protection for me. Nor for Dominick and Ruth, neighbors we have recently lost to cancer.  And no, I did not appreciate the irony of getting breast cancer when the breasts of the earth were supposedly keeping me healthy. 

Protection comes in many forms, though, and I believe my summers in this beautiful mountain valley have been important in regaining my health after my diagnosis.  We get our exercise by climbing the dikes that are scattered throughout the peaks—walls created by molten lava that radiate from the two mountains like wheel spokes.  We hike in firs, pines, and aspens that are a palette of greens in the summer and a mix of yellows, oranges and reds in the autumn.  And this is all under an azure sky.

We relax on our deck, looking at the mountain.  Just looking, seeing the formations caused by trees and boulders that look like a pirate’s face, a skull, an eagle.  And we watch eagles fly above us, bears walk the meadow across from the cabin, and hummingbirds fly in our faces when we don’t keep their feeders full enough.

Some folks like to call this God’s Country and it does feel especially blessed. But it’s not like God saw this pretty place, gave it a nod, and then shirked the rest of the world:  This is my country, and the rest of you can just deal with it. No, I think our blessings are where we are and are what we make of them.   Some of us are given more to work with—I give thanks every day for this beautiful spot—but I don’t think we’re given these gifts to just soak them in selfishly and be smug about our good fortune.  We’re given them to appreciate, to savor, to share, and to protect. 

You can’t help but get over yourself in land like this.  On the one hand, you see how lowly you are—when you stand next to a mountain, you are literally and figuratively tiny.  At the same time, you recognize your importance, because you are a caretaker of this great treasure.

It’s the same thing with our bodies.  We’re caretakers of these wonders.  We seldom contemplate the reality that we inhabit miracles every second of the day, until illness demonstrates that especially strongly.  When our cells stop behaving properly and turn cancerous, we have to really step back and try to comprehend the complexity that we live in. That’s one of those truths we seldom consider—that our bodies are natural wonders.  It takes a malfunction to make us recognize that.  It's a frightening awaking at first, but it can grow into an awesome respect.  

After my diagnosis, I realized that I needed to take care of this body better than I had been doing in the past. I needed to nurture it with nutritious foods, good exercise, and a healthy environment.

It’s all a circle of protecting, of caretaking.

As I sit and look out at the East Peak, at this breast of the earth, I think of my own breasts, my own tiny natural peaks, and I breathe in the mountain air, envision it filling those breasts with health.  Then I go eat some blueberries before my mountain hike in the protection of the Wahatoya.

PHOTOS: Top: The Wahatoya, with the East Spanish Peak on the left, West Spanish Peak on the right. Center:  The East Spanish Peak from our cabin, with clouds building in the meadow.