Monday, March 28, 2011

Journey into Spring: Friendships

Friendships are central to a strong life. Our friends can be our backbone when we are weak, our brains when we are confused, our hearts when we are stricken with grief. They are a treasure, and they are hard to find.

In Dear Heart Come Home, A Path of Midlife Spirituality, Joyce Rupp writes about our middle years as being times of change and growth, much like adolescence, when we begin to question ourselves, where we are going with our lives, and wonder how to be the best us we can be. About her own life, she says:

I’ve searched for a link in my relationship with others and wondered who I wanted to spend the rest of my life with in friendship….

In midlife, she says, we can ask questions we might not have thought of before, we are intentional about our lives in a way that was not possible when we were building our careers and families. And we can wonder if the friends who surround us are the ones we need.

Several years ago, I realized I had two friendships that were toxic. These women, on final assessment, neither wanted to know who I was beneath the surface s nor appreciated what little they did know about the self that mattered to me. I made a conscious decision to break off these relationships. It was actually sadly easy. I simply stopped calling them and they did not call me. And that was that. I guess the ease with which those ties were broken demonstrate that they were extremely weak and reinforced my decision to move on.

I had other excellent friendships that were important to me, so I enjoyed and maintained those. And I had colleagues to supplement these relationships.

Lately, though, I have realized there are women I want to know better and I have made a conscious effort to build new friendships. One, with a woman at church who is wise and funny and good. Another, with a woman I have known for more than 30 years but who I am finally getting to know better, a fellow cancer survivor and writer. Another is a woman who belongs to my dinner group and who loves the outdoors like I do, who I have also known for decades but only peripherally.

I love that I am learning about these women’s lives, and I am sharing myself with them. The me that I am at this moment is thriving with these new anchors in my life. And it has been surprisingly easy. I email, they answer right away, we do lunch, we talk, we laugh, we commiserate, we eat.

These new friends nourish my spirit. Maybe we’ll never be best friends. Or maybe we will be, but I don't spend my time worrying about where we are going. One thing I know now is that the present is a time to celebrate. So, I quietly throw some mental confetti in honor of these new friends. And pop a bottle of virtual champagne in a toast to women everywhere who help one another walk down our roads of change.

And I look forward to growing in friendship.

Sunday, March 27, 2011

Journey into Spring: Bumps on the Road

This is more difficult than I had thought—or than I had hoped. As I write this, a colleague with triple-negative breast cancer is on life support in a Florida hospital after a massive stroke that might have been triggered by the spread of her cancer.

When another colleague who has battled cancer heard the news, she wrote to me, “This is such an insidious disease.”

Insidious is right. Menacing, sinister, dangerous. Interestingly, one synonym for insidious is subtle. And one of cancer’s many challenges is that it is hardly a straightforward disease, with a definite path and a clear outcome. Chances are great that you will survive and get on with your life, as most women do, changed by the experience, often for the better. There is always the chance, though, that it will return, that it will kill.

How can you tell where your path leads? Even with the markers we get from doctors—no signs of cancer—the fear of recurrence is there, and it is real, because recurrence is real. It gets less common after three years for TNBC and increasingly less common after that. But it is real. It never goes away.

And, even though we think we know our bodies, it is easy to lose trust in that knowledge when cancer struck the first time and we tried to talk ourselves into the fact that it was nothing. So is today’s headache really a sinus problem? Is that bone pain actually because of too much exercise? Is that bruise because of lifelong clumsiness that causes me to run into most things in my path?

In the last conversation I had with Linda, she said she was doing well, the treatment was working and she was going on with her life. She had been diagnosed a year and a half ago. She was on my list of people with whom I needed to reconnect. I did, in fact, “friend” her on Facebook just last week, so she knew I was thinking of her. But I never got around to sending the “How are you?” email.

She read my blog and I could often see she was on the site. I wish there were a way to quickly say "hi!" to my individual readers; I suspect that is coming.

Linda was working on her doctorate, which she expected to finish this spring or summer. She had a great academic future ahead of her, as a woman with significant professional experience. One question I wanted to ask was whether she had a job lined up, as she probably did. I was eager to follow her new career, as it was one I shared, and I had encouraged her to get the Ph.D.

But now I have to settle for hearsay—they think the stroke was cancer-related. They don’t know.

They do not expect her to live.

So I mourn the future she should have had, but celebrate the rich past she left behind. And, once again, I am left looking for answers, wondering exactly what happened here.

Insidious.

Dangerous.

Menacing.

Subtle.

Saturday, March 26, 2011

Journey into Spring: Are We There Yet?

Technically it has been spring for days now. In Iowa, we have had snow, tornadoes, and 70-degree weather all in one week. Yes, I guess that sounds like spring.

So, are we already there? Is our journey over, now that the calendar says spring is on schedule? Or is this journey one of those without a clear ending?

When I was going through treatment, I used visualization exercises to help me relax, shutting my eyes and imagining a place of calm and happiness. The image that often came to mind was of the path to our summer cabin. Not the cozy cabin itself, nor the stunning mountain outside the window, or the meadow full of wildflowers.

Just the path.

Really? Was my subconscious working in metaphors? Telling me that, for that moment, the path was what I had, that there was something wonderful up ahead, but for now the focus was on this little journey?

It's a sweet path, lined with trees and, for a few days a year, wild roses. But the scenery elsewhere is spectacular, while the path is, by comparison, ordinary.

I guess if I had imagined the grandeur of the mountain I would have thought I was going to die. Or maybe my subconscious tapped into something--the feeling that, up ahead, there were great things. I just needed to keep going and I would get there.

So, snow today. Who knows what tomorrow. Soon, though, spring.

And, in seven weeks, my five-year anniversary.

Friday, March 25, 2011

Cruciferous vegetables can help fight TNBC

Lab research has once again shown the health benefits of broccoli, kale, cabbage, and other cruciferous vegetables, specifically demonstrating their effects on fighting triple-negative breast cancer. Indole-3-carbinole, which is found in high quantities in these vegetables, has long been considered a potential cancer fighter. Now, research in Italy published in Breast Cancer Research, demonstrates that it shows promise as an injectable anti-cancer agent for TNBC tumors as well as for those that are hormone-responsive. You can download a PDF of the research here.

Researchers worked in the lab on tumor cells. Clinical trials on humans would be the next step. In the meanwhile, it might be good to keep these veggies in your fridge:

Bok Choy
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Kale
Radish
Wasabi





Thursday, March 24, 2011

Journey into Spring: Pondering Our Legacies

When our parents died, my siblings and I had so much to say about them that we packed their gravestone with imagery—mountains, books, flowers, verses.

They were born and raised in Colorado, which explains the mountains, which they loved. Both were readers, therefore the books. They grew and enjoyed beautiful flowers, hence the posies. And, each day when my dad went to work at the steel mill, my mom kissed him and said, “God be with you ‘til we meet again.” That, of course, was on the stone.

I am impressed with the stone carver for packing this all into a nicely designed marker.

But the fact was that we could not encapsulate Mom and Dad’s lives into one simple image. There was too much of them, too much to say.

What do you think your kids would say on your stone? What would you want them to say? Thinking of your life this way makes you focus on the real meaning of what you have done, of what you will leave behind when you die. And, yes, you will eventually die. Cancer makes us think more about our eventual death, but people without cancer die too. We might just be a little more aware of that possibility.

So, what would your stone say?

I have no idea what my kids might say about me. I remember when Josh was in the second grade and I was going to teach a class about The Lion, the Witch, and the Wardrobe at his school. One of his classmates asked what I was like, and he said, “She’s funny.” That always makes me smile—that my sweet little seven-year-old liked that I was funny. I would like to think I am more than that at this point, but I am not entirely sure what it might be. I had not expected him to say I was funny then, so I don’t know what to expect now.

What would I want to say about myself, though? Perhaps that I made a difference, that I was a force for good. That is a goal, one that I can keep my eye on, aspire to, hope for, live by.

It’s a challenging exercise, forcing you to assess where you have been and where you would like to be, who you are and who you would want to be.

Thursday, March 17, 2011

Journey into Spring: Celebrating Good Eggs

Sociologists say that brothers and sisters grow up in a different families, even if we are only a year apart in age. Family dynamics, they say, can be varied enough to change the environment significantly. A parent might have been working last year who is not working this year. Or a sibling’s illness could have stressed the family’s resources and patience. And the year before your big sister became prom queen is far different from the one during which she wore a rhinestone tiara.

Research is mixed on the effects of birth order. Some studies say the oldest in the family is the smartest, with intelligence dropping from there. Scientists speculate that the effects are broader than this, that the oldest children are healthier because they get the strongest sperm and eggs.

As the youngest of five, I take exception to the intelligence issue. But I do sometimes wonder if birth order was the reason I got cancer when none of my older siblings did.

Other research speculates that babies born in the winter are sicker than their spring and summer counterparts, the thinking being that winter babes are more likely to get germs in utero that bug them their entire lives.

I was born at the last of December.

So, I got the old, buggy eggs.

But never mind. I really love my siblings. What’s more, I like them. So, I am glad none of them got cancer and I hope that trend continues. I am not going to dwell on the issue of whether or not birth order was a reason I got sick and they didn’t. I will not acknowledge that they are smarter than me, though.

I am glad they are in my life and I always have been. They are all smart and seriously funny. I have told my oldest sister that she should be a comedian—she could just tell an audience a story about buying rice at WalMart and have them laughing so hard they cry. My brothers tell stories about growing up that make me realize that they, indeed, grew up in a different family. Sometimes I am surprised they grew up at all, what with diving from cliffs into the river, starting their car in the winter with ether and being knocked out in the process, and speeding through intersections because their car could not stop. They make the stories like a comedy routine, one riffing off the other. My middle sister is more sweet than funny, the caretaker of the family, the one we can count on for prayers and unconditional love.

The photo above is of me and my two brothers. I am nearly 5-foot 10-inches, so you can get an idea of what big guys they are, in stature and in personal strength. You need a video to hear their quips, though.

So, on this gorgeous spring day, with highs in the 70s, I remember that summer day three years ago when I shared a mountain hike with some of my favorite people, my brothers. True blessings in my life, true treasures.

Even if they did get all the good eggs.

Older Women with TNBC Benefit from Chemo

Some physicians contend that the risks of chemotherapy are greater than its benefits for older breast cancer patients; new research shows otherwise.

Women over 65 with triple-negative breast cancer with affected lymph nodes benefit from chemotherapy, according to research published in the Journal of the American Medical Association. Researchers surveyed the records of 6,487 women with lymph-node positive disease who were older than 65 and who had been treated between 1975 and 1999 with a variety of chemotherapy regimens. Their basic conclusion: Age alone should not be the determining factor in assessing treatment options.

"I believe older patients in generally good health with triple-negative disease should get the best possible chemotherapy," said researcher Hyman Muss, MD, at the Miami Breast Cancer Conference. Muss is director of geriatric oncology at the University of North Carolina's Lineberger Comprehensive Cancer Center, in Chapel Hill.

The Cancernetwork has an article on the research.

Two April Teleconferences on TNBC

The Triple Negative Foundation and Living Beyond Breast Cancer are sponsoring two teleconferences of triple-negative breast cancer.

April 12, 12-1:15 pm Eastern. Triple Negative Breast Cancer: A Medical Update, with Lisa Carey, MD. She will provide an overview and cover treatments and latest research.

April 26, 12- 1:15 pm. Triple-Negative Breast Cancer: Fear of Recurrence, with Hester Hill Schnipper, LICSW, BCD, OSW-C. She will discuss where to go and what to do once treatment ends.

Register at the TNBC Foundation or LBBC.


Sunday, March 13, 2011

Journey to Spring: Understanding Disasters, Natural and Personal

Bald eagles are hanging out at the lake by us and robins are chirping outside my window. Some early trees are budding, and the sun is no longer a stranger.

The seasons are changing and spring becomes more and more of a promise.

And we need it. The earthquake, tsunami and nuclear disaster in Japan are heartbreaking and terrifying. Apparently the Japanese are better prepared for natural disasters than almost any other country on Earth. Man can seldom beat nature when nature is determined, though.

And, closer to home, bad news lurks.

I got an email from a friend yesterday telling me that her husband has Lou Gehrig’s disease. He is 64 and, while the disease is in its early stages, it is moving rapidly. He is a musician who will soon have to give up his music. They are devastated, reeling from the diagnosis, figuring out how to go on.

I just visited a friend in a nursing home. She is there temporarily, for skilled nursing as she rebuilds her strength after back surgery. She is in pain, but strives to be upbeat. When she tells me she fears she might be there for more than a month, I encourage her to take one day at a time.

Lame advice, but that is really all we have at any point. One day at a time.

So it is difficult for me to take too much pleasure in the sun streaming through my window, at the chubby robin on a nearby branch. But we must see joy in these gifts—they are the blessing of living.

Lymph node surgery may not be needed for early stage breast cancer


The current standard for all forms of breast cancer is sentinel node dissection to determine if the cancer has spread to the lymph nodes. Immediately before surgery, doctors inject dye into the tumor and trace its route. It will go first to the sentinel node. The dye highlights that node, which is removed, along with one or two surrounding nodes, which are all tested for cancer. If the cancer has spread to that node, the patient will have a full axillary lymph node dissection, or removal of all cancerous nodes.

However, according to a phase 3 clinical trial recently published in JAMA (2011), women with tumors smaller than 2 centimeters with affected lymph nodes who had surgery to remove the nodes had nearly identical survival statistics as those who did not have the nodes removed.

This was true no matter the hormone status of the tumor, so it would be true of triple-negative. Researchers clarify that this does not apply to women who are at a high risk for reoccurrence such as those with three or more positive sentinel lymph nodes, larger tumors, or those who received preoperative chemotherapy.

Five-year survival rates were were 92.5 percent for those with no additional surgery and 91.8 percent for those with axillary lymph node dissection, a difference that researchers say is not statistically significant.

Doctors say this research may be a game changer, leading to fewer removals of the lymph nodes, a surgery that can lead to lymphedema and limited range of motion.

Amednews.com and the Cancer Network have both run stories on the study.

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Saturday, March 12, 2011

Journey to Spring: A Tribute To the Caregivers

“When your wife is fighting a life-threatening disease, you want to be at the top of your game,” writes Marc Silver in Breast Cancer Husband: How to Help Your Wife (And Yourself) through Diagnosis, Treatment, and Beyond.

Marc’s wife, Marsha Dale, was diagnosed with breast cancer in 2001. He was a true partner, supporting Marsha as honestly and faithfully as he could—feeling his way at every step of the process. His motto: “Shut up and listen.” To save other husbands the stress and confusion he faced, Marc, a journalist with more than 30 years experience, wrote an excellent book that was my own husband's guide.

In a blog post on caregiving on breastcancer.org, Marc writes:

I was my wife’s strategic adviser at doctor’s appointments, taking notes and reminding her of questions she wanted to ask (but never asking for her). I was her lover, reassuring her that even with a bald head, she was beautiful (and she was!). I was her supply sergeant, dashing out to find ginger candies she craved on a cold winter’s night. I was her confidant, listening to her honest emotions and fighting the urge to say, “Cheer up honey!” when all she wanted to do was talk about how much cancer sucks.

So today, I offer tribute to all the Marcs out there—the husbands, lovers, partners, children, siblings, friends, colleagues, parents, ministers—who walk with us down the breast cancer path. We all need, in some form or another, an adviser, lover, supply sergeant, and confident. And those who step up to the plate to stand by us when we need them, who hide their own fears as they try to quell ours, who strengthen us when our spirits are limp—you are a blessing. And you are blessed.


Friday, March 11, 2011

Journey to Spring: Celebrating Lives
















My husband, Joe, turned 73 today and our grandson Eli turned two months. It is a day of celebration for me, for the little family Joe and I have created: our son Josh, daughter Ellen and her husband Steve, plus little Eli and his big brother Tarin.

And to think it all started when Joe and I first met at a dance in 1969 and he asked if I wanted a drink. I did not understand if he wanted to buy me one or if he was some sort of a bartender. Turns out he was president of the club that organized the dance and he was being sociable in offering me a drink on the house. I said no, but he asked me to dance anyway, and we have been dancing ever since. Sometimes we step on one another’s feet—there were a few years when we did that regularly. But now we are in step with one another quite nicely—and we actually do go out to dances where we tango and swing and do everything but the polka. I grew up with the polka, but Joe does not find its steps to make sense. So I give him that one and we sit out all oompa-oompa tunes.

Joe and I share religious and political views, like many of the same books, enjoy the same leisure activities. He makes me laugh and he makes me smile. We just got home from a walk along the river a mile from our house—it ends up being about a 4-mile loop. We both thoroughly enjoy that outing, as we do the hikes we take at our Colorado cabin. And we like to dance and, when we’re tired, watch Damages and Nurse Jackie on Netflix.

The best thing about us, though, is that we raised amazing kids. Josh and Ellen are both good people and good citizens of the country and the earth. They are smart and funny and loving. They both live more that a thousand miles from us, but they come home often and visit us in Colorado, and we visit them in Washington and Vermont. So I think they enjoy our company as well. And, you know, there is much to be said about grown kids liking to be around you. Much to be said about that.

Josh is a journalist who creates beautiful prose that is thoughtful and important. Sometimes I feel I need to take notes when I read what he has written. He has been published in The Atlantic, Time, Slate, The Nation, among other national and international magazines, newspapers, and online publications. His blog, The Bug Pit, focuses on geopolitical issues in Central Asia.

Right now Ellen keep busy with her two beautiful little boys, the dear Eli and the energetic and highly personable Tarin. She is also a talented artist—some of my favorites are fossil boxes she creates out of found art. She had a show of her work that made the New York Times, along with a sizable photo. Her husband, Steve, is a wonderful husband and father and a creative and successful entrepreneur who works at home, which allows Ellen breaks during the day to go snowshoeing and cross country skiing.

Ellen gets much of her talent for building from Joe, who makes beautiful wood creations in his basement workshop. Right now he is making amazing cutting boards.

I am in awe of these remarkable people with whom I am privileged to share my life. What a blessing. What a joy. I am thankful for all of them everyday.

Happy birthdays, honeys.




Thursday, March 10, 2011

Journey to Spring: Thankfulness, Snarkiness, and Deep Breaths

In my closet, I have several sacks of the cards friends and family sent to me while I went through treatment. I still look through them and smile at all the people who offered support and showed their love. The cards are just a physical reminder of the wonderful thoughtfulness of the people in my life.

How do you thank somebody for showing you that they love you? For loving you? My response was to show them I love them as well.

In some ways, a thank-you note would have been so much easier.

Without doubt I am made better by remembering the good in people. My life is richer and my soul stronger. To be honest, though, sometimes it is darn difficult to be a good friend and family member. Love is so easy to write, so hard to practice.

It can be a personal challenge to get over my snarkiness about friends' and family members' occasional oddities and weaknesses. Sometimes people just get on my nerves. I mean, why is one friend so picky and another so unreliable and another….you get the idea.

I, of course, am perfect.

I noticed my impatience peaking this winter with my realization that as my friends are getting older they are developing some traits I could do without. And I choose strong women as friends, so I am surrounded by a certain amount of bossiness that can be wearing. I seldom am bossy in return, of course, because at that perfection I mentioned.

So, on this journey to spring, I am taking deep breaths and realizing that the picky friend was with me when I was sick and from then on, that the unreliable one was completely dependable in her love, that quirks make them interesting and I have always loved interesting people. And that they love me despite everything.

So, here I am, breathing deeply and smiling at the memories of the love that surrounded me when I was sick and that surrounds me still.

And resolving to continue giving thanks by showing my own love.

Inhale, exhale, inhale, exhale.

Wednesday, March 9, 2011

Let's Journey Together to Spring

Celebrations of spring have been a constant of human cultures for thousands of years. Some say Easter was named after Eostre, the great mother goddess of the Northern European Saxons. Others says it was Ostara, a Norse goddess of fertility. Both names are variations of an ancient word for spring, eastre.

Many of us have faced a hard winter, both literally and figuratively. The weather throughout the world has been brutal, with hurricanes and earthquakes, tornadoes and ice storms. The lucky among us have taken refuge in the comfort and warmth of our homes. The less fortunate have lost homes and livelihoods and lives. Still others see this weather as a gift and head to the slopes to revel in the beauty of the snow.

In winter, mother nature can be gorgeous, but she can also be foreboding, a killer.

A diagnosis of cancer is a bit like winter. It is dark, menacing, dangerous, a killer. Yet, it can challenge us to strengthen good relationships and rebuild bad ones, to give thanks for the good we have as we gird ourselves to face the bad. To see that life itself has been a gift full of beauty that we often have been too busy to appreciate fully, sometimes to even notice.

Today, most Christian churches begin the season of Lent, a time of reflection and meditation in preparation for Easter. When I was little, we always gave things up for Lent—usually candy. And on Easter we would gorge ourselves on jelly beans and chocolate eggs. As I got older, I saw the weakness of this plan—who cared about what Easter meant spiritually when you finally got to eat lots of sugar?

My adult choice was, too often, to just do nothing different in Lent, or worse, to criticize others' choices. The colleague who was giving up French fries, I thought, was making a spiritually meaningless gesture. Yet I made to effort to make a gesture at all of my own.

Like many cancer patients, I rediscovered my spiritual side on this journey to regain my health, and that was a true gift. So, as we go through this season in preparation of the rebirth of spring and as many of you go through the cancer journey, I plan to take a few minutes each day in this blog to focus on the good, to share love and caring, to celebrate life and rebirth.

And this coincides with a milestone on my passage through the land of cancer. I was diagnosed on a beautiful May morning, when the air was warm and clear, the sky azure, the blossoms sprouting, the natural world green. On May 16, 2006, that all turned grey for me as I heard the words, “Patricia, the test came back; it is positive for cancer.”

I will soon celebrate five years from that day. Those of us with hormone-negative disease get to breathe a little easier three years after diagnosis, as that is when the risk of recurrence drops significantly. Five years, though, becomes an important benchmark.

So, journey with me, with hope and love throughout the ending days of winter and help me welcome the spring with joy. Cancer-free joy, the best kind.

Wednesday, March 2, 2011

Antibody May Separate TNBC into Aggressive and Less Aggressive Subgroups

High levels of the antibody Ki-67 was associated with higher rates of recurrence and lower survival for triple-negative patients, according to new research. And low levels signaled a less aggressive form of the disease. Researchers say this could lead to two separate subgroups of TNBC with significantly different levels of aggressiveness and prognosis. The research, on 105 patients who received neoadjuvant (after surgery) Adriamycin and Cytoxan, was published in the journal Breast Cancer Research. Antibodies are part of the immune system.


Tuesday, March 1, 2011

Phase II study of entinostat and anastrozole for TNBC

From a News Release from Syndax Pharmaceuticals:

WALTHAM, Mass., March 1, 2011 -- /PRNewswire/ -- Syndax Pharmaceuticals, a clinical-stage epigenetics oncology company, announced the National Cancer Institute (NCI) will sponsor a multi-center phase 2 study of Syndax's lead product entinostat, a novel inhibitor of histone deacetylases (HDAC), and anastrozole, an aromatase inhibitor, in postmenopausal women with operable triple negative breast cancer to evaluate biomarkers and surrogates for response. The trial, to be conducted under a Cooperative Research and Development Agreement (CRADA) executed between the NCI and Syndax, will investigate whether patient tumors can be reprogrammed to express estrogen receptor and render them to be sensitive to hormonal agents. This trial is based on animal data being published in the March 1, 2011, issue of Cancer Research.

Laboratory studies by Dr. Angela Brodie, professor of pharmacology and experimental therapeutics, and Gauri J. Sabnis, Ph.D., assistant professor of pharmacology and experimental therapeutics at the University of Maryland School of Medicine, in collaboration with Saraswati Sukumar, M.S., Ph.D., professor of oncology and pathology at the Johns Hopkins University School of Medicine, provided the basis for the phase 2 clinical trial. Their work demonstrates that entinostat induces hormone sensitivity in an animal model of triple negative breast cancer and that the combination with aromatase inhibitors prevents tumor growth as well as tumor metastasis.

"In the pre-clinical study that is being published in Cancer Research we demonstrated that entinostat can induce re-expression of estrogen receptor and aromatase in triple negative breast cancer cell lines and render them sensitive to an aromatase inhibitor," said Saranya Chumsri, M.D., assistant professor of medicine at the University of Maryland School of Medicine and a medical oncologist at the University of Maryland Marlene and Stewart Greenebaum Cancer Center, principal investigator of the trial. "Moreover the combination of entinostat with an aromatase inhibitor suppressed the growth of tumors in an animal model of triple negative breast cancer. Given this promising data, we are evaluating entinostat with anastrozole in a neoadjuvant setting to see if we can extend the benefit of hormone therapy seen in patients with estrogen receptor positive breast cancer to those with triple negative disease - where cytotoxic therapy is the only treatment option."

While the mortality rate in breast cancer has decreased in the past few decades, some subsets still have poor outlooks. With the advent of targeted therapy, particularly endocrine and anti-human epidermal growth factor receptor 2 (HER2) therapies, the outcome of breast cancer has changed dramatically. Nevertheless, approximately 15 to 20 percent of breast cancers lack expression of all three constructive cell surface receptors, namely estrogen receptor (ER), progesterone receptor (PR) and HER2, hence the term "triple negative" breast cancer (TNBC). Due to an absence of ER and/or PR, these tumors typically do not respond to endocrine therapy like tamoxifen and aromatase inhibitors, which have minimal toxicities and are generally well tolerated. For that reason, the treatment option for these tumors is solely chemotherapy.


TNBC declining in white women

Hormone-negative breast cancer rates dropped for white women ages 40-49 and 60-69, according to new data from 2003 through 2007. Using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) data, researchers noted a slight increase in hormone-positive cancers. Rates for African-American and Hispanic women showed little change. Kathleen Doheny in WebMD offers an overview of the research, which was published online in Cancer Epidemiology, Biomarkers & Prevention.

Low exercise and high BMI are risk factors for TNBC

Increasing your exercise levels and reducing your body mass index can help reduce your risk of triple-negative breast cancer, according to research using data from the Women’s Health Initiative. Researchers analyzed records of 162,000 women, 3,116 of whom had complete tumor marker data; 307, or 10 percent, of these were triple-negative.

The research was published in the March issue of Cancer Epidemiology, Biomarkers and Prevention. Michele Sullivan, of Internal Medicine News, explains the research and interviews the lead researcher, Amanda I. Phipps, Ph.D.

Of special note is that fact that weight gain between age 35 and 50 was the most risky. A body mass index above 31 and below 23.75 were also risk factors.