You're a survivor. That's the good news. But it's not the end of the story.

Thanks to medical advances, the number of cancer survivors has been increasing. But often, those survivors are at a loss to know how to navigate their lives after cancer. How to take care of their health. How to deal with the fears of recurrence.

Survivorship - from the perspective of patients, family and friends - is the focus of a series of educational and fellowship sessions beginning Thursday in Bismarck.

Wanda Agnew, a dietitian with Bismarck-Burleigh Public Health, said that the series will focus on issues that survivors deal with, before, during and after treatment.

During the series, professionals in the community will share their expertise on topics such as food and fitness, sexual relationships, tobacco and spirituality. The series is sponsored by Bismarck-Burleigh Public Health and the Bismarck Cancer Center through a grant provided by the North Dakota Cancer Coalition, a work group of the Healthy North Dakota initiative. Healthy North Dakota was launched by Gov. John Hoeven in 2002 as a cooperative public health improvement effort by numerous state and local agencies.

The sessions will be held at the Bismarck Public Library from 5:30 to 6:30 p.m., right after work, and will include nutritious snacks, Agnew said. The sessions will offer food, fellowship and facts, she said. Participants who attend at least three sessions also have a chance to win a weekend trip for two to Medora.

The public perception has been that cancers can primarily be attributed to environment or genetics, Agnew said, but research now shows that 40 percent of all diagnosed cancers can be attributed to poor nutrition and use of tobacco, a percentage Agnew calls astounding.

What that means is that those factors are in our power to change, she said.

"We can survive together and improve quality of life," Agnew said.

Cigarettes are still a problem and cause too many deaths, she said.

"We eat poorly because we can," she said. "We're not trained to think of prevention. We believe that someone will treat us (or) we believe our health is the responsibility of our insurance company. Somebody (else) will fix it."

Diets are more than a fad; they're about quality of life for a lifetime, she said: Diets should include more fiber, fruits and vegetables and smaller amounts of animal protein.

"We were once hunter-gatherers, eating a plant-based diet of roots and berries and game," Agnew said. "Only in the last part of history have we had the opportunity to overeat."

Jill Goetz of Bismarck Cancer Center, who is helping coordinate the series, is herself a survivor of colorectal cancer, diagnosed when she was only 36.

When her treatments were over, the questions arose:Now what do Ido to take care of myself? she said.

"A lot of emotions are involved," Goetz said. "Will it come back in a year? Or five years? Will I be here five years from now?"

Goetz's aftercare involved diligently going to her screenings, eating nutritiously, exercising and maintaining a positive attitude, including getting support from other survivors.

"People are on the go all the time, eating poorly,"which is a challenge to self-care, Goetz said.

People should remember, "you are in control,"she said.

Aftercare is important, but statistics show that even after cancer treatment, only 15 percent of people were eating all their fruits and vegetables and only one-third had increased their activity levels, Agnew said. Furthermore, 54 percent of survivors said they didn't get enough information about aftercare.

This series aims to give people those informational tools, she said.

The Bismarck Cancer Center, which is owned jointly by Medcenter One and St. Alexius Medical Center, working together with Bismarck-Burleigh Public Health, is a great asset to the community, Agnew and Goetz said.

"People can get their treatments here," Goetz said, in many cases avoiding the expensive and dislocating experience of taking treatments away from home.

No registration or fee is required to attend the series.

(Reach reporter Karen Herzog at 250-8267 or karen.herzog@;bismarcktribune.com.)