Publications
Insight, Fall 2009
In our fall issue, get tips on understanding and managing fear of recurrence. Find information on a new treatment that may help women with metastatic and hereditary breast cancers. Learn how Elizabeth Edwards lives well with advanced breast cancer, and read the inspiring story of a young woman who shares Mrs. Edwards’ diagnosis.
Table of Contents
Could It Come Back? Managing Fear of Recurrence
When Amanda Nixon, 31, of San Diego, California, was being treated for inflammatory breast cancer in 2006, she never contemplated the possibility that the cancer might return. She had formed a tight-knit circle with three women who had finished treatment, and all were doing well. Then one woman in the group had a recurrence.
"I was so focused on the fight and getting through treatment that it didn’t dawn on me I could ever have a recurrence—until that happened," Amanda says.
Fear of recurrence is a "nearly universal experience," says Hester Hill Schnipper, LICSW, BCD, OSW-C, chief of oncology social work at Beth Israel Deaconess Medical Center in Boston.
"You are finished with treatment and starting to look and feel better, but it’s not unusual to ask, ‘Now what might happen to me?’" says Ms. Hill Schnipper, who had breast cancer twice and wrote the book After Breast Cancer: A Common-Sense Guide to Life After Treatment.
It’s reasonable for you to fear the prospect of the cancer coming back. You may worry about having to get treatment again or about pain or discomfort. These fears are normal, but they can interfere with your ability to care for yourself. Knowing what triggers your fears and learning to manage them can help you move forward with your life.
Understanding Your Fears
Dealing with fears of recurrence can be difficult because your loved ones may not understand how you feel. Your caregivers have their own feelings about the disease and its impact on your life, and they may not know how to support you while managing their own emotions.
Amanda’s mother did not want to consider the possibility of the cancer coming back.
"Her attitude was, ‘It’s over now, you’re better,’" Amanda says. "My boyfriend felt the same way."
It’s common for loved ones to assume that once you finish treatment, you’re "cured." During treatment, you probably focused on making medical decisions and keeping your family or job afloat. Now that you have time to cope with cancer’s emotional impact, your caregivers may have moved on.
"Most people do not appreciate the reality that treatment ending is not ‘the end,’" Ms. Hill Schnipper says. "The fear ebbs and flows in different women. Some are afraid when treatment ends but become less fearful as they reach 18 months to three years out and are feeling better. Others become more anxious because they reason that any trouble is more likely to happen a couple of years out."
Your fears may change over time, depending on your personality, your treatment plan and your long-term outlook. Taking a daily pill like tamoxifen or an aromatase inhibitor could increase your fears by reminding you every day of your diagnosis. On the other hand, a daily pill may comfort you because you feel you’re doing something to "fight" the disease.
Maria Franks, 51, of Skokie, Illinois, says her fears are less intense as she approaches the five-year anniversary of her diagnosis. However, some fears are resurfacing as she prepares to stop taking tamoxifen.
"You feel supported in treatment and like you’re at least doing something. Then you realize treatment will be over and you will be on your own," Maria says.
If you have triple-negative breast cancer, you may have fears sooner than women with other disease types. After standard therapies like surgery, radiation and chemotherapy, you have no further treatment. Ending treatment and regular doctor’s appointments abruptly can make you feel vulnerable.
Depending on your personality, the stage of your diagnosis also can affect your fears of recurrence. Lourdes Bellas, 44, of Miami, Florida, says her fears have not been a major problem because the cancer was found early and tests suggested she had a low risk for recurrence.
"My doctor is really positive about my situation and I see no reason not to be positive as well," she says.
Stage plays a different role in Amanda’s fears, which stem in part from knowing her friend who recurred had a less aggressive cancer than she did.
To protect yourself and lessen your fears, pay attention to your body, communicate with your doctor at regular appointments and find strategies to cope when your fears resurface.
Identifying ‘Triggers’
Certain occasions, or even words, sights or smells, can bring on fears, sometimes at a moment’s notice. Follow-up tests and doctor’s appointments are common "triggers," as are significant dates like the anniversary of your diagnosis, birthdays, holidays and other milestones.
Maria did not realize how much her doctor’s appointments prompted fears until she went from a three-month follow-up schedule to six months.
"Getting away from the medical setting really helped lessen the fear," she says. "I realized I had a life outside health care again."
Amanda experienced what she calls "paralyzing fears" whenever she went for a mammogram or MRI. Eventually, she sought help from a psychosocial oncologist, a specialist in the psychological and behavioral aspects of cancer.
Ms. Hill Schnipper says that once you identify your triggers, you can prepare for them.
"Have someone who is a calming presence come with you to your appointment, or plan something nice for afterwards, like lunch with a friend," she says. "Identify people you can talk to about your fear, whether ‘breast cancer buddies’ or someone else."
Dealing with unpredictable situations can be much more difficult, she adds. "You might hear about someone who recurred or happen upon an obituary for someone with breast cancer," Ms. Hill Schnipper says. "Someone might come up and start telling you about a cousin with breast cancer who died. It’s not something you can prepare for."
One way to cope with others who share news about another person’s diagnosis is to remind them gently that your situation is unique. Say, "Thank you for the information, but this is not helping me right now."
Another common trigger: physical symptoms like cough, back pain or fatigue. We all have these types of aches and pains, but after breast cancer treatment, you might think your symptom means the breast cancer is coming back.
Don’t be surprised if you have at least one symptom that scares you in the first few years after your treatment. But if an ache, pain or cough lasts more than two weeks, get it checked by a doctor, Ms. Hill Schnipper says.
Even breast self-exams might prompt some fears. "I always had lumpy breasts, and the breast tissue around the lumpectomy and the area treated with radiation is never the same," Maria says. "So there are times when I feel like there is something there. [When appropriate,] I have had MRIs and ultrasounds done, and those have helped allay my fears."
Tools for Taking Control
Develop strategies to manage your fears and regain a sense of control. The women who work with Ms. Hill Schnipper find it helpful to write down situations or experiences that trigger their fears.
"When something happens, they can tell themselves, ‘That is one for the list,’" she says. "It gives them a place to put it."
Amanda relies on a different kind of list. Her psychosocial oncologist advised her to write down every action she has taken to fight the breast cancer—all treatments, medicines and lifestyle changes. Whenever Amanda feels scared, she mentally runs through the list.
"It’s so easy, but it’s an amazing tool, and it changed my life," Amanda says. "I could still be operating out of fear, but I am not."
Lourdes finds comfort in going to church and talking with other women affected by breast cancer. To deal with specific triggers, like hearing about someone who recurred or passed away, she replaces that person in her mind with someone who has lived long-term and is doing well. She limits the time she spends researching breast cancer.
Maria uses her fear of a recurrence to stick with a healthy lifestyle.
"Fear can motivate me to work out when I feel tired," she says. "It can keep me on track with making the effort to eat healthy foods and offer healthy options for my family. I was always too busy before."
She also finds comfort in doctors who listen to her fears, especially when she has a troubling symptom. Maria has switched doctors a few times to find the right fit, but the effort has been worth it.
"It is reassuring to have someone listen and validate your feelings and give you options—not just say everything is going to be all right," Maria says. "My advice to other women would be to trust your instincts, listen to that inner voice and find a doctor who truly listens."
Talking openly about your fears is important. Your doctor, family and friends will assume you’re fine if you always put on a brave face.
Tell your doctor what you do or do not want to know about the risk of recurrence. Ask what you can do to lower your risk. Find one or two relatives or friends who are comfortable letting you voice your fears and ask the "What if?" questions. Or you might turn to a woman with breast cancer or to a support group.
Trudy Helge, PsyD, a clinical psychologist with Women’s Mental Health Associates in Philadelphia, recommends stress reduction techniques like meditation, relaxation, breathing exercises or guided imagery.
"These have been shown to reduce the physiological stress response, acting like a dimmer switch," Dr. Helge says. "They’re often the first thing I recommend to patients who are experiencing fear or anxiety."
Getting Support
Sometimes it can be challenging to acknowledge your fears without letting them take over your life. Seek professional help if your fears begin to interfere with your daily functioning.
"If you’re anxious for a few days around your appointments or a significant anniversary, that is well within the range of ‘normal,’" says Dr. Helge. "But if you’re noticing that your [anxiety is] lasting for a couple of weeks and getting worse, it’s time to get help. Depression can affect your physical recovery, and it is treatable."
Even if you don’t feel the need to see a mental health professional, you may wish to talk with other women who are going through similar experiences. Amanda and Maria say that the support in local breast cancer groups is a great boost.
To speak one-on-one with someone trained to offer advice and support, call our Survivors’ Helpline at (888) 753-LBBC (5222). Our volunteers are all at least one year from completing treatment and know what you’re going through.
PARP Inhibitors: The Next Great Breast Cancer Treatment?
A new family of medicines called PARP inhibitors dominated headlines from the June annual meeting of the American Society of Clinical Oncology. The medications, which target the way cancer cells repair themselves, could revolutionize treatment for breast and other cancers, doctors say.
Early studies, while small, suggest PARP inhibitors work powerfully against some types of metastatic triple-negative and hereditary breast cancers. The findings were so impressive that the New England Journal of Medicine took the unusual step of calling for FDA approval of a PARP inhibitor based on results of a Phase I clinical trial, only the first of three steps normally needed for approval.
Why the rush to get these medicines to you? How do PARP inhibitors work, and when will they be available? Some answers to these questions can be found in DNA.
The ABCs of DNA
Every cell, whether healthy or cancerous, contains DNA (deoxyribonucleic acid). DNA instructs cells when and how to grow and when to stop growing. Each piece of DNA is made up of two strands (or sides) with thousands of directions.
Sometimes DNA strands have "mistakes," or mutations. We may be born with these errors (hereditary mutations) or obtain them at some point in life (spontaneous mutations). For example, if you inherited a BRCA1 or BRCA2 mutation from your mother or father, your cells have a DNA mistake that increases your risk for breast cancer. Other breast cancers are caused by spontaneous mistakes in one or both DNA strands, causing cells to grow out of control.
Depending on the situation, DNA’s double-sided structure both protects us from disease and challenges our ability to fight it. When one strand has a mutation, the other picks up the slack. That’s why BRCA mutations do not always cause breast cancer—one strand has a mutation, but for cancer to develop, the other strand must also have one. To complicate matters, cells have many enzymes that help them fix their own DNA.
"That’s important, because we’d get cancers a lot earlier if our bodies didn’t regularly repair DNA," says Julie Gralow, MD, a medical oncologist from the University of Washington and member of our Medical Advisory Board.
One example is the PARP (polyadenosine-disposphate-ribose polymerase) enzyme, which fixes DNA breaks in both healthy and cancerous cells. PARP can lessen the effectiveness of treatments that depend on DNA damage.
"Chemotherapy causes DNA breaks, so if the PARP comes along and repairs the breaks, then the chemo won’t work as well," says Joyce O’Shaughnessy, MD, lead investigator of a PARP study who practices medical oncology at Baylor Sammons Cancer Center in Texas.
How PARP Inhibitors Work
The goal of PARP inhibitors is to prevent DNA from fixing its mistakes. PARPs are considered targeted therapies because they kill cancer cells but spare healthy ones. PARPs may be given as pills or by vein (intravenously).
Researchers predict the best candidates for PARP-inhibiting therapies are cancers vulnerable to DNA breaks. Those include BRCA-related and triple-negative breast cancers.
In BRCA-related cancers, "the cells are so unstable because they have reduced ability to repair their DNA," Dr. Gralow says. "BRCA tumors are very sensitive to shutting down with treatment with PARP inhibitors."
Triple-negative breast cancers occur spontaneously but the basal-type form, which has a unique cell pattern that encourages tumor growth, shares a trait with BRCA-related cancers.
"Some cancers, triple-negative is one of them, have a very basic defect in the ability to repair both strands of the DNA," Dr. O’Shaughnessy says. "When the cancer loses the ability to repair the double-strand break, it depends on PARP to repair the strand. PARP holds the cell together so it doesn’t implode, and the cancer cell is reliant on the PARP enzyme to grow."
Dr. Gralow and others believe PARP inhibitors could be used against other cancers with defects to their DNA, including ovarian and colon cancers, and melanoma and lymphoma.
"We might be able to sort out those patients that would be helped [by looking at gene patterns in the cancers]," Dr. Gralow says. "Then PARPs would be expanded beyond the triple-negative and BRCA positive populations."
What the Studies Found
The strongest findings from ASCO report on two medicines, BSI-201 and olaparib. Also in the pipeline: ABT-888 and AG014699. Check lbbc.org for updates.
ASCO, Abstract 3. In this randomized, phase II study, the PARP inhibitor BSI-201 was given by vein in combination with gemcitabine (brand name: Gemzar) and carboplatin (brand name: Paraplatin). The 116 participants had triple-negative metastatic breast cancer. Most had disease in the lung or liver. Half the participants received chemotherapy alone (the standard treatment); the other half got chemotherapy plus BSI-201 (the treatment under study). Chemotherapy was given once a week for two weeks with one week off; BSI-201 was given twice a week for the first two weeks.
Results. About 62 percent of the study group benefited from treatment, versus 21 percent of those who received standard treatment. The tumors shrank in 48 percent of study participants versus 16 percent of the standard group. Women in the study group lived an average of 9.2 months after treatment versus 5.7 months in the standard group. Some participants reported tiredness, upset stomach and vomiting, but doctors noted little difference in side effects between the groups.
ASCO, Abstract CRA501. Olaparib, a PARP inhibitor pill, was the focus of this phase II study for people with BRCA1 or BRCA2 mutations whose metastatic breast cancer grew despite previous treatment with chemotherapy. All 54 participants took olaparib daily for 28 days, but half took 100 mg (the minimum effective dosage) and half took 400 mg (the maximum safe dosage).
Results. Of those in the 400 mg group, 38 percent saw their tumors shrink. (Researchers await results from the 100 mg group.) Participants had few serious side effects but reported fatigue and nausea.
New England Journal of Medicine, June 24, 2009. The 60 participants in this phase I trial had metastatic breast, ovarian or prostate cancer, and one-third had BRCA1 or BRCA2 mutations. Previous treatments failed to control their disease. Initially, participants received 10 mg daily of olaparib (two weeks on, followed by one week off), with researchers slowly increasing the dose to 600 mg twice daily. Early results looked promising, so researchers enrolled a second group of participants, all with a BRCA1 or BRCA2 mutation. These participants took 200 mg of olaparib twice daily.
Results. Only participants with BRCA mutations benefited from the PARP inhibitor. Testing showed olaparib quickly found the DNA mistake, inhibited the PARP and exited from the body. Participants who took the 200 mg dose twice a day had mild stomach upset but no serious side effects.
Volunteers Needed
PARP inhibitors need rigorous testing before they may become standard treatment. Under U.S. Food and Drug Administration (FDA) guidelines, new treatments must be proved safe and effective.
To speed the FDA approval process, researchers need volunteers to take part in studies of PARP inhibitors. If you have triple-negative or BRCA-related metastatic breast cancer, you can help by asking your doctor about open clinical trials. As of press time, clinicaltrials.gov knew of at least six studies open to participants with breast cancer.
The largest study, recruiting now, is a phase III trial of BSI-201 available at 66 medical centers nationwide. Known as NCT00938652, the study has the same structure as the one presented at ASCO. You may be able to take part if, after a diagnosis of triple-negative metastatic breast cancer, you did not receive chemotherapy or you had up to two regimens that did not include platinum-based medicine.
Doctors are hopeful the needed 420 participants will sign up within the year. The full findings, expected in June 2012, will compare treatment arms for progression-free and overall survival over a 12-month follow-up period. While we wait, the FDA could approve BSI-201 based on results of an interim analysis, findings given before completion of a study.
Timeline for Approval
BSI-201 could be approved for metastatic, triple-negative breast cancer within two years, a remarkably short time for FDA approval, say Dr. O’Shaughnessy and Dr. Gralow. More studies would then be needed to get BSI-201 approved for early-stage disease.
Ongoing trials could speed approval of olaparib, but Dr. O’Shaughnessy says the FDA might consider approving it now. "You cannot do a randomized trial in BRCA1 and BRCA2 patients because there just aren’t enough of them," she says. "In my opinion, the ASCO data should be grounds for approval. It was powerful, scientifically sound data."
Other PARPs require further study. But the excitement over these medicines means competition among manufacturers. That’s good news for you, because it means more and more clinical trials.
Just as important, the discovery of PARP inhibitors reinforces the trend toward targeted treatments.
"This is where we’re going, looking at specific sets of tumors, specific sets of patients, and designing treatments that match the specific subset of cancer," Dr. Gralow says. "Doing those things is what is going to get us better outcomes and better survival in breast cancer.
Life in a Different Key: Q&A with Elizabeth Edwards
Elizabeth Edwards spoke in April at our 3rd Annual Conference for Women Living with Advanced Breast Cancer, where she shared her experiences with breast cancer. Her story of life after her 2004 diagnosis has inspired countless women and two books, Resilience and Saving Graces: Finding Solace and Strength from Friends and Strangers. Mrs. Edwards’s efforts have raised awareness of the disease around the world.
After the conference, we talked more with Mrs. Edwards about how she lives well with metastatic breast cancer, what motivates her each day and her plans for the future.
LBBC: Mrs. Edwards, thanks for taking time to talk with us more about your journey. We know our conference attendees were very inspired by your story, but we were curious about what you took away from the conference and the women you met.
Mrs. Edwards: It was like sitting around with relatives. I speak at a lot of events where there are healthcare providers and other people I admire greatly, but this was different. This was like sitting in your kitchen with people you’ve lived with, because you’ve lived the stories they’ve lived. I felt like I could say anything, and I said things I don’t usually say because I felt so comfortable. I hope the audience felt the same way.
LBBC: Was this the first conference where you spoke solely to women with metastatic breast cancer?
Mrs. Edwards: Logic and statistics will tell you that they’ve always been in the crowd, but in terms of making up the entire audience, this was the first time.
LBBC: At the conference you mentioned that you had found a sisterhood in the women you’ve met. Could you explain how this sisterhood has helped you during your treatment and beyond?
Mrs. Edwards: I thought this even before I was diagnosed, but when you see women with scarves over their heads yet they’re smiling and full of life and have such determination, I think, how did they get to be this strong? I know for a fact that cancer does not only pick strong women. It’s the community of sisters that helps us be strong in moments when it’s so easy to be weak. And they call on parts of us, or create parts of us, that we didn’t know existed.
I often quote a poem in talks I give that can be applied to this. To paraphrase, learning you have cancer is transposing life to a different key. That’s not an exact quote, but it’s what happens after we hear the words "you have cancer." We have our life transposed to this—an entirely different key. It’s a minor key that seems a little off tune, and we have to change our lives to accommodate it, but it’s made immensely easier by this sisterhood. And that’s what I’ve gotten from the community. Not just the hugs or the sweet notes, which matter, but this greater sense that there’s really nothing that cancer can stop me from doing. It may take away days and years from me, but there’s no other part of my life that it can touch. And in so many ways, my life is even better and I am even stronger.
LBBC: What do you think is the importance of an organization like LBBC for women diagnosed with metastatic breast cancer?
Mrs. Edwards: If you live in a metropolitan area or go to a big healthcare center, you meet other people and can sit down and talk with them. But I travel all over the country to communities where women can often feel isolated. They’ve told me how alone they feel, and how they don’t have the kind of support they wish they had. And I have told them, on more than one occasion, about LBBC because it’s one way they can connect with kindred spirits. The fact that LBBC provides a forum for that kind of interchange—I wish you could see their faces light up as they hear that there is, in fact, some place they can go. I hope I continue to have the opportunity to send more people your way so they can share the experience of being in that family living room, either physically as you gather for conferences or metaphorically as you communicate over the Internet.
LBBC: Do you think the younger generation of women, including your daughter, is more informed about breast health? What do you wish for them?
Mrs. Edwards: They are certainly much more informed, especially about breast cancer. I’ve got lots of things I want to do with the healthcare system, but one of the things I want to make certain is that we’re informing people before age 40 of what type of self-examinations they should be doing, what their family history is and what’s their own susceptibility. I also think it’s important for us to reach out to rural populations, women of color and particularly young women about aggressive kinds of breast cancer. We’ve come a long way from when I was 27 years old in terms of what this next generation knows, but we still have quite a long way to go.
LBBC: Finally, we know you’ve been supportive of breast cancer legislation and have been a strong proponent of clinical trial participation. What else are you advocating for on behalf of women with breast cancer?
Mrs. Edwards: Obviously, improvements to our healthcare system are going to help women with breast cancer get treatment. Too often, the women I speak with don’t have my [quality] health care. They don’t have my [quality] insurance. That is so incredibly important. The hopelessness that these women feel is truly overwhelming. And it creates a moral dilemma for everyone in this country.
I also want to concentrate on post-treatment care. There’s a lot of care you need after you’ve won the battle. This is especially true for women with metastatic breast cancer. You’re going to need to know whether this pain is something you should be getting checked or what kind of exercise or foods would be most helpful. There’s no insurance code for that kind of post-treatment care. And if you don’t have an insurance code, good luck making certain that those services are available. So starting to value the post-treatment patient—perhaps not with the same ferociousness we expect during treatment, but with the same tenderness, care and understanding—is crucial. We’ve got to find ways to add to the coverage we have for post-treatment care and treat survivors with the same amount of dignity we hope we’re giving them during active treatment. If you can tell, I’ve got a lot on my agenda.
Healing Through Faith
After Dana Dukes, 38, lost a close friend to breast cancer in 2006, her friend’s inner strength stood out in her mind.
"My friend never faltered in her faith during her journey," Dana says. "She always kept a positive attitude, even at the end."
Little did Dana know that her own faith would be tested two years later. In December 2008, she felt a lump when her arm brushed against her right breast. She immediately made a doctor’s appointment. Two days later, she had a mammogram and ultrasound, and the day after Christmas, she had a needle biopsy. On December 30, Dana learned she had stage IV breast cancer.
"I fell down crying when I heard the news. I knew what my doctor was saying, but I didn’t want to believe it," Dana says.
Being diagnosed during the holidays added to Dana’s anxiety. Memories of her friend, who had passed away in December, resurfaced. Dana felt like a burden to her friends and family. And on top of all that, she had to care for her three children.
Dana’s healthcare team was committed to beginning her treatment quickly. She began chemotherapy the first week of January. She was scared, but she had to believe the treatments would work.
"I had faith that God would bring me through this," she says. "It was that same faith that helped me get through each day of treatment."
Dana wasn’t prepared to lose her hair. She decided to cut it before beginning treatment, assuming hair loss would be less traumatic if her hair were already short. She was known for having different, unique hairstyles, but this style was one she didn’t want.
"There’s a difference between cutting your hair because you want to and cutting it because you have to," she says.
As an African-American woman, Dana felt there weren’t a lot of hairstyle options available. She looked through wig magazines and couldn’t find any women who looked like her. Dana wondered if she would ever look and feel "normal" again. Instead of letting her frustration affect her self-esteem and self-image, she turned her focus to the arts.
"Being able to express myself through words and music helped me deal with my situation just a little bit better," she says.
These activities also helped her place less emphasis on her appearance. Dana looked in the mirror each day and told herself she looked beautiful, even if she didn’t feel pretty. Her feet were swollen, but she still wore skirts and sandals. Friends who saw her wig thought she had a new haircut.
"Why should not having hair make me any less beautiful?" Dana says. "Even when you’re sick from treatment or your feet are swollen, you’re still beautiful. I think it’s important for women to know that."
Dana initially had support from her friends and family, but many were unable to handle the stress of her diagnosis. They refused to speak with Dana about treatment and began making excuses about why they couldn’t help her. Dana didn’t understand why the people she had always supported were unwilling to do the same for her. Even though she was disappointed, she remained positive.
"I don’t have room for bitterness," she says. "My health is my number one priority."
Dana searched for an opportunity to share her positive attitude with others. In June, LBBC featured her in a photo shoot for women living with advanced breast cancer. Dana first learned about LBBC as a recipient of the Cis B. Golder Quality of Life Grant, a program that provides small, one-time grants to newly diagnosed women with financial need who live in the Philadelphia region.
"The photo shoot gave me a chance to show that there is beauty amongst disease," Dana says. "It was the best thing I’ve ever done."
Participating in the photo shoot is one item Dana has checked off on her lengthy to-do list. She hopes to inspire other women living with metastatic disease by becoming a motivational speaker.
"I want to let them know that it’s okay to cry and it’s okay to be angry, but it’s also okay to laugh," she says. "I believe the more positive you are, the less chance cancer has of taking over.
"Just smile. Believe that you can still have a great life despite this disease. Don’t take anything for granted. Live every day as if it’s the last day you have on this earth."
Sandy’s Tips
For those of us who care deeply about breast cancer, October can be a tough month to shop. Visit any store or Web site, and we’re confronted with dozens of pink products being sold for the "battle against breast cancer." How can we know our purchases will make a difference? Try these rules of thumb:
- Know the nonprofit recipient. The company should identify the recipient on its packaging. Find out how the nonprofit spends its money. LBBC spends more than four-fifths of donations on programs.
- Focus your spending. Buy products that support your favorite organization and make a bigger impact.
- Find out how much money goes to the group. The manufacturer should explain its financial commitment. Look for a total dollar amount, a donation by number of pieces sold or a percentage of total sales.
Remember, an outright gift is the easiest way to ensure that 100 percent of your donation goes to the charity of your choice. At LBBC we accept gifts online at lbbc.org; just click on "donate," and we’ll lead you through a safe, secure process. I also invite you to contact me directly at or (610) 645-4567. Happy shopping!
Sandy Martin
Director of Development and Communications
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