Saturday, April 27, 2019

Five Truths About Triple-Negative Breast Cancer That Can Give You Hope

It’s maddening that come patients are being denied the hope they need when diagnosed with triple-negative breast cancer (TNBC). Mind you, TNBC is nothing to mess with, but my mantra through my 13 years living through and writing about the disease is, “Most women with TNBC survive and go on to live full lives.” I’ve heard that fact spoken by numerous top researchers through the years. And we have the evidence to support that statement.

So let’s talk about a few facts that may help settle some fears.

1. The overall survival rate five years after diagnosis for TNBC is 77 percent. Yes, that is not as good as hormone-positive cancer (93 percent), but it means the odds are still seriously in your favor. And in some studies, the survival rate for TNBC was as high as 85 percent. With continued research, improved tools for early diagnosis, and new treatment options, survival rates for women being treated now are likely to be much higher than that.  

2. If TNBC is going to recur, it will usually do so within the first three years after diagnosis.  

3. After five years, your chances of recurrence are minimal. Ninety-seven percent—as in almost all—of those who survived five years recurrence-free remained so after ten years and 95 percent were recurrence-free after 15 years.  

4. Survival rates are measured from time of diagnosis, so you may be closer than you think to the magic five years.

5. If you have a second cancer, especially several years after your original diagnosis, it might be a second primary, and not a recurrence.  I repeat: Not a recurrence. With a second primary, you’re just starting from the beginning, with a new cancer. Not ideal, but a with significantly better prognosis than a recurrence. Some types of cancer treatment, such as chemo and radiation, can make you more susceptible to a second primary. I have survived the first diagnosis for 13 years and the second for four years, with no signs of disease.

For More Research:

Surviving Triple-Negative Breast Cancer: Hope, Treatment and Recovery, by Patricia Prijatel. (That's me.)

Long-term survival outcomes of triple-receptor negative breast cancer survivors who are disease free at 5 years and relationship with low hormone receptor positivity, British Journal of Cancer. January 2018

Predictive factors and patterns of recurrence in patients with triple negative breast cancer. Annals of Surgical Oncology, February 2014

Constructing a Clinicopathologic Prognostic Model for Triple-Negative Breast Cancer, Physician Education Resource, 2017

Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence, Dent et al. Clinical Cancer Research, August 2007

Understanding Statistics Used to Guide Prognosis and Evaluate Treatment, American Society of Clinical Oncology.   

Assessing the prognostic factors, survival, and recurrence incidence of triple negative breast cancer patients, a single center study in Iran. PLOS1, January 2019

Sunday, February 17, 2019

Study Shows Mammography Saves Lives

Hundreds of thousands of women's lives have been saved by mammography and improvements in breast cancer treatment since 1989, according to a study published in CANCER, a peer-reviewed journal of the American Cancer Society.

According to the report,,female breast cancer mortality rates in the United States increased by 0.4% per year from 1975 to 1990. Since 1990, those rates have fallen between 1.8% and 3.4% per year, a decrease that is attributed to increased mammography screening and the improved treatment.

Estimates range from more than 305,000 to more than 483,000 women whose lives were saved between 1990 and 2015, depending on different background mortality assumptions.Researchers estimated that in 2018 alone, an estimated 27,083 to 45,726 breast cancer deaths were averted. 

Researchers analyzed breast cancer mortality data and female population data for U.S. women aged 40 to 84 years over the past three decades.

“Recent reviews of mammography screening have focused media attention on some of the risks of mammography screening, such as call-backs for additional imaging and breast biopsies, downplaying the most important aspect of screening—that finding and treating breast cancer early saves women's lives. Our study provides evidence of just how effective the combination of early detection and modern breast cancer treatment have been in averting breast cancer deaths,” said R. Edward Hendrick, PhD, of the University of Colorado School of Medicine,

Only about half of U.S. women over 40 years of age currently receive regular screening mammography, he said. “The best possible long-term effect of our findings would be to help women recognize that early detection and modern, personalized breast cancer treatment saves lives and to encourage more women to get screened annually starting at age 40.”

[PAT'S NOTE:] Both my cancers were caught early on mammograms, so I'm onboard with this one.




Tuesday, October 9, 2018

Weight Gain Associated with TNBC Risk

In a study of postmenopausal women, participants who lost weight had a lower risk of developing triple-negative breast cancer than those who maintained or gained weight. The research was published online in CANCER, a journal of the American Cancer Society.

The findings suggest that weight loss may help lower postmenopausal women’s breast cancer risk. [NOTE: I was postmenopausal and I lost weight right before I was diagnosed with TNBC—both times.]

Although obesity has been strongly related to breast cancer risk, studies examining whether weight loss might reduce postmenopausal women’s risk have provided mixed results. To examine the issue, Rowan Chlebowski, MD, PhD, of the City of Hope National Medical Center in Duarte, California, and his colleagues analyzed information on 61,335 women participating in the World Health Initiative Observational Study who had no prior breast cancer and had normal mammogram results. The women’s body weight, height, and body mass index were assessed at the start of the study and again 3 years later. 

During an average follow-up of 11.4 years, there were 3,061 new cases of invasive breast cancer diagnosed. Women with weight loss at 5 percent or more had a 12 percent lower breast cancer risk compared with stable weight women, with no interaction by body mass index. Weight gain of 5 percent or more was associated with a 54 percent higher incidence of triple negative breast cancer.

“Our study indicates that moderate, relatively short-term weight reduction was associated with a statistically significant reduction in breast cancer risk for postmenopausal women,” said Dr. Chlebowski. “These are observational results, but they are also supported by randomized clinical trial evidence from the Women's Health Initiative Dietary Modification trial where, in a randomized clinical trial setting, adopting a low-fat dietary pattern that was associated with a similar magnitude of weight loss resulted in a significant improvement in breast cancer overall survival. These findings, taken together, provide strong correlative evidence that a modest weight loss program can impact breast cancer.”
 

Friday, October 5, 2018

Nanoparticles Improve TNBC treatment

The chemotherapy drug doxorubicin encapsulated in nanoparticles an be especially effective in treating triple-negative breast cancer, according to a study published in Precision Nanomedicine.   
Researchers found that increased cell kill in triple-negative breast cancer cells was associated with the smallest size of nanoparticles and the slowest release of doxorubicin.
"Nanomedicine is a very exciting avenue in modern drug development," said Adam Friedman, MD, director of the Supportive Oncodermatology Clinic at GW Cancer Center, professor of dermatology at the George Washington School of Medicine and Health Sciences, and senior author of the study. "Nanotechnology offers many benefits, including the ability to purposefully customize your drug or diagnostic at the atomic scale, enhancing its ability to interact with its biological target and improve outcomes and potentially safety."
Friedman acknowledges that this study is an initial step, but it "provides clues for new potential strategies utilizing and manipulating nanotechnology to overcome cancer cell drug resistance. We have our work cut out for us, but this study shows that we are moving in the right direction."

Wednesday, October 3, 2018

Eating Bacon Might Increase Your Breast Cancer Risk

A new study in the International Journal of Cancer reviewed previous research on the link between meat consumption and breast cancer risk and concluded that processed meat increases your breast cancer risk significantly. This includes bacon, ham,  sausage, hot dogs, salami, and beef jerky.

Researchers found that eating processed meat was associated with a 9% higher breast cancer risk. Interestingly, they found no significant association between red (unprocessed) meat intake and risk of breast cancer. Risk was increased in both ER-negative and ER-positive cancers. Of the 15 studies, two found a greater link between a diet of processed meat and ER-negative cancers.  

"Cutting down processed meat seems beneficial for the prevention of breast cancer,” said lead author Dr. Maryam Farvid, of the Harvard T.H. Chan School of Public Health.

Monday, June 4, 2018

TNBC patients with high T-cell signatures may have higher survival rates

Here’s one way triple-negative cancer works, according to researchers at the University of Michigan Rogel Cancer Center:
Tumor cells reprogram metabolic pathways to gain control over a type of immune cell that allows cancer growth.
Here’s the technical explanation: Myeloid-derived suppressor cells that live in and around a cancerous tumor encourage a stem cell-like growth that’s linked to TNBC. The more of these suppressor cells a patient has, the worse the outcome. This means the patient’s immune system isn’t strong enough to fight against the tumor.
And when there are a large number of myeloid-derived suppressor cells, immunotherapy treatments tend to be ineffective because the immune T-cells that immunotherapy targets are suppressed.
By looking at triple-negative breast cancer cells, researchers found that the metabolic process by which cells break down glucose also regulates the expression of a specific isoform that in turn causes more suppressor cells to develop. The immune system can’t mount enough of an assault on the tumor cells, which translates to poor outcomes in some TNBC patients. 
“We hope that by understanding the biology better, it may lead to new ways to help these patients,” says Weiping Zou, M.D., Ph.D., the Charles B. de Nancrede Professor of Surgery, Pathology, Immunology and Biology at the University of Michigan.
Looking at samples from 250 triple-negative breast cancer patients, researchers found that when the metabolic pathway for glycolysis was enriched, so were the immune suppressor cells — and this linked with worse overall survival. In contrast, tumors with a high T-cell signature exhibited fewer of these suppressor cells and the patients had better outcomes.
The study is published in Cell Metabolism.

Wednesday, February 21, 2018

What if the news is really bad? What do we want from our doc?


"Doctors still are underprepared for these difficult discussions.
They tend to focus on the disease and not the patient."


Imagine you get the worst news possible: You have late stage cancer. Your doctor lays out the treatment options: chemo, radiation, surgery. You hear lots of numbers, some of them probably related to your prognosis, but you’ve just been told you have cancer. They make no sense. You trust the doc, as do many patients, so you do what the doc tells you. It’s all about a cure.
What if, instead of burying you with data, the doctor instead sat down, looked you in the eye, and clearly and honestly explained your prognosis, then began talking about making you comfortable and giving you the best quality of life possible, but did not promise a cure.
Which doctor would you trust most?  

Monday, January 22, 2018

Breastfeeding Cuts TNBC Risk in Younger Women

Women under the age of 50 who breastfed for at least 24 months over their lifetime had a lower risk of developing triple-negative breast cancer, in a recent large-scale study conducted through multiple breast cancer research organizations. For women with three or more full-term pregnancies, risk increases two-fold if they did not breastfeed or only did so for less than a year. No increase in risk was seen for women who breast-fed for more than a year.  The  study was led by the Cancer Prevention Institute of California and epublished ahead of print on January 13 in the International Journal of Cancer.

None of these associations were observed among women age 50 or older.

So, that's why breastfeeding both my kids did not help me. I was 60 at diagnosis.

The study was based on data from 5,669 women who participated in the San Francisco Bay Area Breast Cancer Study, the Northern California site of the Breast Cancer Family Registry, and the Los Angeles County Asian American Breast Cancer Study. Of these, 558 had TNBC.



Thursday, November 16, 2017

TNBC Tied To Type 2 Diabetes in African-American Women


African-American women with type 2 diabetes had a higher risk of developing estrogen receptor (ER)-negative breast cancer, which includes TNBC, in research published in Cancer Research, a journal of the American Association for Cancer Research.  

Here’s what’s really interesting: The association was observed only among women with BMIs under 30, which could mean that abnormal metabolic status may play a larger role in ER-negative breast cancer than obesity.

The results showed an increased risk of ER-negative breast cancer primarily in black women who had type 2 diabetes for at least five years. Researchers found no association with ER-positive breast cancer in the same group.

African-American women who get breast cancer are more likely to get TNBC than white women, with double the incidence as compared to white women, according to the paper’s author, Julie R. Palmer, ScD, associate director of Boston University’s Slone Epidemiology Center. And type 2 diabetes is also twice as prevalent in African-American women.

“We are still trying to understand the basic biological processes that lead to ER-negative breast cancer. One way to do this is to study factors that are more common in an African-American population,” she said. Several studies suggest that diabetes is a risk factor for breast cancer and insulin resistance is a factor in TNBC.

The study was based on information provided by participants in the Black Women’s Health Study (BWHS, which uses twice-yearly questionnaires from 59,000 African- American women from across the United States.


 “Our findings may account for some of the racial disparity in breast cancer, and could partly explain why mortality from breast cancer is so much higher in black women than white women,” Palmer said. “Women could reduce their chances of getting ER-negative breast cancer if they could avoid developing type 2 diabetes. Monitoring of blood sugar levels to identify pre-diabetes may allow for early interventions to prevent diabetes.”

For more information on TNBC, check out my book, Surviving Triple-Negative Breast Cancer.  And your support of this site is important. Even a small donation keeps me going. Check the "donate" button at the top right of the page. Thanks much.

Wednesday, October 4, 2017

Ten Years After Breast Cancer And Competing In Ironman Triathlon

This coming February will be Julie Desloge’s 10th cancerversary—she had triple-negative—and she’s leading up to the celebration by training for her first full Ironman race. (Shouldn't that be Ironwoman?)  She will swim 2.4 miles, bike 112 miles and run 26.2 miles, all in less than 17 hours.
Julie biking in the Hagg Lake Triathlon in Oregon in July.
            Chew on that a minute. She will be running a marathon plus biking more than a hundred miles and swimming the equivalent of 85 laps in an average swimming pool. If you drove 112 miles in your car at 70 miles per hour, it would take you an hour and 36 minutes. But Julie’s doing it on her bike, plus that marathon and swimming thing. In 17 hours.
            Phew, Julie. Way to kick cancer out of your life.
            We're all doing what we can to recover and maintain our health, but it's nice to have Julie out there overachieving for all of us.
            She also doing it to raise money for The Breast Cancer Research Foundation.  which gets top ratings from Charity Navigator
            You can follow Julie’s blog as she prepares for the race, which is scheduled for April 2018. Julie has been racing since 2010, just two years after her diagnosis. Here’s some of what I wrote about her in my book:
Here’s one way to get over the worries about cancer treatment and the fears of its return: run a triathlon or two. That’s the approach Julie Desloge took—she completed her first sprint triathlon in June 2010, a little more than two years after she was diagnosed with triple-negative.  She participated in two additional races that summer—and her radiation oncologist was her teammate on the third.            On that race, her doctor swam 1.5 kilometers, her husband ran 10 kilometers, and Julie biked 40 kilometers. That translates to slightly less than a mile swim, a 24.8-mile bike ride, and a 6.2-mile run.
            Julie was diagnosed with a 2.6-centimeter tumor in February 2008 when she was 41. She had neoadjuvant chemotherapy—four rounds of Taxotere and Cytoxan—that got rid of all but .3 centimeters of the tumor, a nearly 90 percent reduction.            Easily speaking the jargon on cancer, she says, “No pathologically complete response for me.”  And, while her response was only partial, it nevertheless was significant, offering her a positive prognosis.
            A lumpectomy followed chemo, with radiation after that.
            Risk factors?  She’s negative for the BRCA mutation, but wonders about her reproductive history—she started her periods young, at age 11.  And she’s the mother of three children, who were 11, 9, and 6 at the time of diagnosis, although she breastfed all three for nine to ten months.
            She was about 15 pounds overweight when she was diagnosed; Taxol added another 8 pounds or so.  Her weight continues to be a challenge, even with her high level of exercise.  She now weighs more than she did at diagnosis, although much of that is probably muscle, which weighs more than fat.  I haven't really found the key to unlocking much weight loss,” she says.  Still, we’re talking about being only slightly beyond her ideal—Julie says her BMI is a healthy 24.8.
            She had been exercising regularly before cancer, doing cardio and resistance exercises four to five days a week. But she upped the ante after treatment and hit the triathlon circuit near her Portland, Oregon home.         Cancer, she says, not only gave her motivation to maintain a healthy lifestlye, but it provided a chance to look outside herself at what others are going through. She’s bothered when friends protest that they should not complain about any problems they encounter, given what she faced in cancer treatment.  “Pain is pain,” she says.
             Julie remains grateful for her continued health and her ability to compete, knowing how many other beautiful women have been denied that chance. In a recent post about gratitude, she quoted Psalm 139:14:
“I will give thanks to You, for I am fearfully and wonderfully made; Wonderful are Your works, And my soul knows it very well.” As a breast cancer survivor, I have been in awe about how fragile and strong the human body can be at the same time, affected with disease, yet able to withstand the rigors of cancer treatment. I have always been grateful for that, and grateful to be able to thrive at life now.
Julie is carrying a list of the names of breast cancer survivors in whose honor she competes and a list of the names of those in whose memory she competes. She'll carry the names with her across the finish line. If you want to add a name, let her know.


Thursday, September 14, 2017

Premenopausal Women with Belly Fat More at Risk of TNBC


Me: Normal BMI, but with
tummy fat. I've had
TNBC twice. I'm 11 years
past the first diagnosis.
two years past
the second.
Women whose fat accumulates around their stomachs and internal organs—called visceral fat—are more at risk of estrogen negative breast cancer, including triple-negative, according to research published in the Oncologist. The increased risk comes even if they are not overweight—that is, if they have a normal body mass index (BMI). The risk increases is they are past menopause. [PAT’S NOTE: This is me.]
            By contrast, overweight women whose fat accumulates in the thighs, hips, or buttocks—called subcutaneous fat—are more at risk of estrogen positive breast cancer. In this case, having a high BMI and being premenopausal increases the risk.
            “A possible reason is that subcutaneous fat is involved in estrogen production, which may promote ER+ breast cancer,” says corresponding author Zhigang Yu at the Second Hospital of Shandong University in China. “Visceral fat is more closely related to insulin resistance and may be more likely to promote ER- breast cancer.”
            For the study, researchers recruited 1,316 Han Chinese women between 25 and 70 in Northern and Eastern China who were newly diagnosed with breast cancer and compared their body types to women who had not had breast cancer.
            Asian women tend to be slimmer than their American counterparts, but those who are overweight typically carry visceral fat. Subcutaneous fat is more common in the United States. Could that be why ER+ cancer is more common here?

To sum up: 
• Women with belly fat who are past menopause are at increased risk of TNBC, even if they are not overweight.
• Women who over overweight, with fat in thighs, hips, and buttocks and who are premenopausal are at risk of ER+ breast cancer.