A growing number of physicians are already monitoring cancer patients and healthy people for vitamin D. Last fall the Institute of Medicine announced new daily recommended intakes of vitamin D for nearly all adults and children in the United States and Canada. Although the IOM did not specifically address vitamin D and cancer, it reported that 600 IUs daily meets the needs of most people. Higher amounts are often prescribed to cancer patients; sometimes a weekly dose of 50,000 IU is necessary to treat severely deficient people.
Friday, April 29, 2011
Thursday, April 28, 2011
chief, Oncology Social Work, Beth Israel Deaconess Medical Center.
Adjunct Professor, Simmons College School of Social Work. She is author of Woman to Woman: A Handbook for Women Newly Diagnosed with Breast Cancer and After Breast Cancer: A Common-Sense Guide to Life After Treatment.
Monday, April 25, 2011
Chronic stress acts as a sort of fertilizer that feeds breast cancer progression, significantly accelerating the spread of the disease in animal models, researchers at UCLA's Jonsson Comprehensive Cancer Center have found.Researchers discovered that stress is biologically reprogramming the immune cells that are trying to fight the cancer, transforming them from soldiers protecting the body against disease into aiders and abettors. The study found a 30-fold increase in cancer spread throughout the bodies of stressed mice, compared with those that were not stressed.It has long been thought that stress fuels cancer growth in humans. This study provides a model that not only demonstrates that stress can speed up cancer progression but also details the pathway used to change the biology of immune cells that inadvertently promote the spread of cancer to distant organs, where it is much harder to treat.The study is published in the Sept. 15 issue of the peer-reviewed journal Cancer Research."What we showed for the first time is that chronic stress causes cancer cells to escape from the primary tumor and colonize distant organs," said the study's first author, Erica Sloan, a Jonsson Cancer Center scientist and a researcher with the UCLA Cousins Center for Psychoneuroimmunology. "We not only showed that this happens, but we showed how stress talks to the tumor and helps it to spread."In addition to documenting the effects of stress on cancer metastasis, the researchers were also able to halt those effects by treating stressed animals with drugs that block the nervous system's reprogramming of the metastasis-promoting immune cells, called macrophages.Beta blockers, used in this study to shut down the stress pathways in the mice, are currently being examined in several large breast cancer databases for their role in the potential prevention of recurrence and cancer spread, said Dr. Patricia Ganz, director of cancer prevention and control research at the Jonsson Cancer Center. If preliminary findings indicate benefit, early-phase clinical trials are being considered at the Jonsson Cancer Center testing beta blockers as a means of preventing breast cancer recurrence.Other healthy lifestyle behaviors, such as exercise and stress-reduction techniques, may also influence the biological pathways described in the study."We're going to be focusing on younger women, because they may have a multitude of things weighing on them when they're diagnosed with breast cancer. Younger women have more significant life demands and typically are under more stress," Ganz said.Ganz said her proposed research will focus on "host factors," or things affecting the patient that may be aiding cancer progression and which could help explain why a group of patients with the same type and stage of disease have varying rates of recurrence and cancer spread."This study provides evidence for a biological relationship between stress and cancer progression and identifies targets for intervention in the host environment," Ganz said. "Because of this study, we may be able to say to a patient in the future that if you follow this exercise regimen, meditative practice or take this pill every day, it will help prevent recurrence of your cancer. We can now test these potential interventions in the animal model and move those that are effective into the clinic."In Sloan's study, mice with breast cancer were divided into two groups. One group of mice was confined in a small area for a short period of time every day for two weeks while the other group was not. The breast cancer cells were genetically engineered to include the luciferase gene, which is the molecule that makes a firefly glow. The growth and spread of the cancer in the mice was monitored using sensitive cameras that can pick up the luciferase signal. This allowed Sloan and her team to observe both the development of primary tumors and the spread of cancer throughout the body, said senior study author Steven Cole, an associate professor of hematology–oncology and a Jonsson Cancer Center researcher.What was interesting, Cole said, was that the primary tumors did not seem to be affected by stress and grew similarly in both groups of mice. However, the stressed animals showed significantly more metastases throughout the body than did the control group. The cancer, in effect, acted differently in the stressed mice."This study is not saying that stress causes cancer, but it does show that stress can help support cancer once it has developed," Cole said. "Stress helps the cancer climb over the fence and get out into the big, wide world of the rest of the body."Cole said Sloan detailed the biology of the stress-induced changes in the cancer cells along every step of the pathway, providing a roadmap by which stress promotes cancer metastasis. Additionally, Sloan proved that using beta blockers in stressed mice prevented the same cancer progression seen in the stressed mice that did not receive medication.When cancer occurs, the immune system sends out macrophages to try to repair the tissue damage caused by the uncontrolled growth of cancer cells. The macrophages, in an attempt to help, turn on inflammation genes that are part of the normal immune response to injury. However, the cancer cells feed on the growth factors involved in a normal immune response. Blood vessels that are grown to aid healing instead feed the cancer the oxygen and nutrients it needs to grow and spread, and the extracellular matrix, which provides structural support for normal cells, is attacked during the immune response, helping the cancer cells escape from the primary tumor and spread to distant parts of the body."Many of the genes that promote cancer metastasis get turned on during the immune response by macrophages," Cole said. "This study shows that stress signaling from the sympathetic nervous system enhances the recruitment of macrophages into the primary tumor and increases their expression of immune-response genes that inadvertently facilitate the escape of cancer cells into other parts of the body."Sloan showed that the beta blockers prevented the macrophages from hearing the signals sent by the sympathetic nervous system and stopped them from infiltrating the tumor and encouraging cancer spread.The study was funded by the National Institutes of Health, the U.S. Department of Defense and the Jonsson Cancer Center.UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson Center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2010, the center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 10 of the last 11 years.
Sunday, April 24, 2011
As Christians around the world celebrate Easter, let us offer our hearts and prayers to all those who strive to make the world a more loving, kind, and just place, no matter their religion or beliefs.
Below are some of the prayers we offered in my church on Good Friday. I cannot top them, so I share them below.
Prayers for Authorities
Let us pray for those in authority throughout the world....
For all the peoples of the earth, their leaders, and all who hold office....
For Barack our President, for our Congress and Supreme Court, our local governments and courts, and all civil servants....
For peacemakers, diplomats, and those who strive for peace and the general welfare; for the armed services and all in harms way because of war....
For doctors and nurses, hospitals and hospices; for police and firefighters; for all who protect the weak and serve the common good....
For farmers and corporations, for workers and trade union leaders, reformers and visionaries....
For artists and performers; for poets and writers; for journalists and filmmakers....
That they may receive every godly gift of discernment, compassion, integrity and courage, to build healthy communities and make a lasting peace on earth, let us pray to the Lord.
Prayers for Those who Suffer
Let us pray for all who are suffering and in need....
For the poor and oppressed, the exploited and despairing, the sick and the suffering....
For victims of envy, discrimination and revenge....
For all who live in fear, anguish, rage, and violence....
For all who hunger for food, for work, a home, and a holy purpose in their lives....
For all who face death, the loss of love, the crushing of dreams, the crippling of body or mind, let us pray to the Lord.
For all who long for family, friendship, children, a sense of belonging and being known....
For all in danger and captivity, all who long for peace and freedom and safety....
That we may follow Christ in sharing all human suffering as our own....
Loving God, comfort all who suffer, and teach us to cherish Christ’s image in all people: those who are like us and those who are strange to us. Strengthen our hearts in your service, and fulfill in our works of compassion your Love made flesh, Jesus Christ our Lord. Amen.
Prayers for People of Faith
Let us pray for those whose faith is not our own....
For Jews, Muslims, Hindus, Buddhists, Native Americans, Shintoists, Sikhs, and every people of faith....
For their rabbis, mullahs, priests, lamas, shamans and holy teachers....
For those whose faith is known to God alone....
For all who condemn, persecute or martyr others in the name of religion....
For all who suffer and die for their conscience’s sake....
That as Christ came as a stranger to befriend us, we may learn to welcome those unknown and alien to us, let us pray to the Lord
Saturday, April 16, 2011
Friday, April 15, 2011
My friend, Deb Wiley, posted this amazing photo on her blog, Planting Queen. Deb says the photo reminds her of "what gardening is all about: Joy." I recommend a visit to her blog for more excellent photography and perspective.
Wednesday, April 13, 2011
Tuesday, April 12, 2011
In 2005—TNBC had not even been named yet.
By 2010—several hundred publications in that year alone.
• About a third of breast cancer deaths come from TNBC.
• Claudin low breast cancer, a new subtype, is also likely to be TNBC.
• Inherited breast cancer—BRCA1 and BRCA2—women with these have 50-80 percent risk of breast cancer over their lives. Recommend mastectomy and removal of ovaries for these women. If women with BRCA1 mutations gets cancer, 80 percent of time it is TNBC. This is called BRCA-associated breast cancer. Why is there such close associations? If a woman without mutation gets TNBC, what does this tell us? We don’t know yet.
• No PARP inhibitors approved yet. Interesting study in BRCA-associated cancers. Women given just a PARP inhibitor—without chemo---and the tumor shrunk. Drugs in early development, may be a positive way forward for those with inherited mutations.
• What about women without inherited mutations? (Sporatic cancers.) A study on women with metastatic TNBC who were given iniparib, a PARP inhibitor, which was added to the therapy; it controlled cancers longer; women lived longer. Not replicated in a larger study, however. Disappointing result.
• Clinical trials are essential—consider enrolling.
Relapse to the brain. Reseachers pay attention to brain metastases because the brain acts differently—it responds to surgery. Most common type to move to brain is Her2-positive. Second is TNBC. With Her2, can move only to brain. TNBC tends to come back in the brain as well as other places at the same time; it may have to be treated differently than Her2-positive cancer. Brain metastases research is a very active field. In the past, there had been a tendency to lump brain metastases together—breast, melanoma, lung. Now, break into different types of cancer and different types of breast cancer. The blood-brain barrier needs to be considered. Research now specifically on PARP inhibitors for TNBC that has metastasized to the brain. There have been advances in standard therapy, such as surgery, for brain metastases.
What can do to reduce risk, especially without risk factors. Most of the time, we do not know why one woman gets breast cancer and another one doesn’t. There’s the risk of getting the cancer—research is ongoing on how to peg individual risk. Separate from that is how to reduce the risk of an already-formed cancer from coming back. Know how to prevent from recurring—surgery, chemo, radiation. Beyond that, everything is an investigation. There is reason to think a healthy lifestlye helps across the board. Simply do not know how it affects the risk of relapse.
Are treatments different for women with BRCA mutations and those without? No, at this point both would be treated the same.
CMF: One of our earliest drug regimens that has been effective but is being replaced by more modern regimens. Still being used for women who cannot tolerate newer ones. One study showed that CMF actually better than AC chemo. Not a significant benefit, but would not avoid CMF.
Follow-up Testing: What is the best method in following after treatment? ASCO Guidelines—physical and careful history every three to six months for the first three years; every six to 12 months in years four and five. Breast imaging, usually mammography, but sometimes MRI every year. In most cases, no bone scans or CAT scans, or blood work.
Metaplastic breast cancer as is relates to TNBC. Metaplastic are relatively unusual. (As few as 1 percent of all cases.) It is a specific subtype. Most breast cancers are either ductal or lobular. Others are pathologically different. Metaplastic has a funny appearance. Unusual. Almost always TNBC. Don’t know if there is a specific treatment difference. Acts like other breast cancers. May have more of the claudin low subtype.
If you have cancer in one breast, should you have the other breast removed? Prophylactic mastectomy in general is limited to those with an inherited risk. If have risk factors and are having mastectomy, it makes some sense to remove both breasts at the same time. For women who have sporatic TNBC, the decision between lumpectomy and mastectomy is a personal one. The decision there is not different for women with TNBC as opposed to others.
Monday, April 11, 2011
Monday, April 4, 2011
A two-year study at Southern Methodist University will analyze the psychological and social challenges faced by young minorities with triple-negative breast cancer. Researchers will survey up to 60 women recently diagnosed with TNBC or those who test positive for a mutation of the human gene that suppresses tumors, BRCA1.
Below are portions of a news release from SMU. (I have edited out phrases such as an "aggressive form" and, my favorite so far, "this unconventional subtype.")
The study is probing patients' stress, anxiety and concerns about the psychological and social hurdles they face, said Georita M. Frierson , principal investigator. SMU is collaborating on the Triple Negative study with the University of Texas Southwestern Simmons Cancer Center, a National Cancer Institute-designated cancer center.
"We don't know anything about this population psychologically," said Frierson, an expert in behavioral health psychology and an assistant professor in the SMU Department of Psychology. "But based on this study, for any of their concerns we could tailor a psychological intervention to help other women like the women in my pilot. These women will be our pioneers in the psychological area to help their sisters that may have Triple Negative in the future."
For younger, minority women: Different cancer, different challenges
Triple Negative patients face far different challenges than women with traditional hormonal-type breast cancer, whose psychological and social challenges have been widely examined in the published psychological cancer literature, Frierson said. Traditional hormonal-type patients are typically over age 50, in a later career phase, raising their families, and probably have peers who may be struggling with a chronic illness.
In contrast, a Triple Negative patient is young, maybe mid-career, may not have started a family, and her peers are largely healthy and active. Because Triple Negative is a very aggressive cancer, Triple Negative patients can have lower survival rates and higher recurrence rates, and the medical treatment is different from hormonal-type cancer, Frierson said. For example, while chemotherapy can be an effective treatment for the Triple Negative patient, it can lead to short-term menopause, which may or may not be reversible, she said.
Breast cancer is the second leading cause of cancer death among women after lung cancer. In 2010, there were more than 192,300 new breast cancer cases in the United States, with more than 40,000 deaths.
The subtype is called Triple Negative because it tests negative for all three of the hormone receptors that fuel many types of breast cancer: estrogen, progesterone and human epidermal receptor 2. Some traditional breast cancer hormonal treatment therapy drugs, such as Tamoxifen, aren't effective against Triple Negative Breast Cancer.
Results will establish protocol to develop interventions
Health care providers, social workers and others can use the study data to develop programs to reduce and manage stressors in the lives of Triple Negative patients, Frierson said.
"We want to fill a gap that needs to be addressed," she said. "The information from this pilot can help us develop programs and support groups to ease the burden on Triple Negative survivors. When we talk about breast cancer, many people think about the woman in her 50s. But these are young cancer survivors. Really understanding those differences is important."
Health providers who have agreed to refer patients with medical approval by their physicians include: U.T. Southwestern and Parkland Hospital in Dallas; and Moncrief Cancer Institute in Fort Worth. As a partner in the study, The Cooper Institute in Dallas will provide participants with fitness testing. The survey is also online, so a woman outside the Dallas-Fort Worth area can answer a one-time questionnaire and participate in the study.
The survey, which takes 45 minutes to an hour to answer, asks questions about physical activity, diet, nutrition, compliance with doctor appointments, stress levels, body image, quality of life, relationships, friendships, fertility, depression, anxiety, sleep and fatigue.
The research is funded with a two-year, $50,000 grant from The Discovery Foundation, Dallas.
Orlando, Fla. -- In mice models of breast cancer, researchers at the Georgetown Lombardi Comprehensive Cancer Center, a part of Georgetown University Medical Center, found that vitamin D significantly reduced development of estrogen receptor-positive (ER+) breast cancer both in lean and obese mice, but had no beneficial effect in estrogen receptor-negative (ER-) cancer. In fact, obese mice destined to develop ER- breast cancer were clearly worse off than lean ER- mice if they were given vitamin D in their diet.
The researchers, who will present their study at the American Association for Cancer Research (AACR) 102nd Annual Meeting 2011, also found that vitamin D reversed insulin resistance in obese mice, no matter which breast cancer subtype they later developed. In lean mice, however, there was no evidence that vitamin D increased insulin sensitivity.
"Use of vitamin D supplementation is clearly tricky. In the many studies that have been done studying the effect of vitamin D in different cancer types, there is no straight link between use and benefit," says the study's lead investigator, Leena Hilakivi-Clarke, Ph.D., a professor in the Department of Oncology.
For example, in the colon, vitamin D seems to reduce the risk of cancer development, but it may not have any effect on later stage colon cancer. There is also concern that vitamin D may increase the risk of prostate, esophagus and pancreatic cancer. In work she has conducted in endometrial cancer, Hilakivi-Clarke found that although vitamin D was not beneficial in lean mice, in obese animals it reverses both early and advanced stages of the cancer.
"This is not a vitamin that should be taken lightly," she cautions. "People need sufficient amounts because it has beneficial effects for overall health that have nothing to do with preventing cancer. But for those who want to boost their use of vitamin D, it is important that they have their individual levels tested by a physician, and that they discuss their desire to use supplements."
IMPACTS OF VITAMIN D INTAKE IN MICE MODELS (findings in Hilakivi-Clarke lab)
Lean mice Obese mice ER+ breast cancer Risk reduced Risk reduced ER- breast cancer Dose dependent benefit No benefit Insulin resistance No benefit Reversed Endometrial cancer No benefit Risk reduced
In their ER- breast cancer study, the researchers fed lean mice two doses of vitamin D - 15 or 20 K international units [IU] VD3 - from puberty onset onwards for 24 weeks. They found that the lower dose (15 K IU) of VD3 significantly reduced mammary tumor incidence as well as time for tumors to develop in lean mice, when compared to mice that were fed control diet. A higher dose (25K IU) was used in mice fed the obesity-inducing diet because vitamin D becomes trapped in fatty tissue and thus is reduced in the blood stream, Hilakivi-Clarke says. Obese mice destined to develop ER- cancer that were given vitamin D developed the highest incidence of breast cancer.
In their ER+ breast cancer, only the higher vitamin D dose (20K IU) was used. This dose significantly reduced breast tumor incidence in lean mice, compared to control or obese animals. Additionally, obese mice fed vitamin D developed fewer tumors than obese mice not supplemented with it, says Hilakivi-Clarke.
In both mouse models of breast cancer, obese mice developed insulin resistance, and vitamin D supplementation reversed it. However, vitamin D in lean mice tended to reduce insulin sensitivity in both mouse models, she says.
The researchers are currently studying possible mechanisms by which vitamin D may reverse obesity induced increase in breast cancer and insulin resistance, and preliminary results suggest vitamin D reverses the action of genes which promote inflammation, cell proliferation and survival, and this might involve epigenetic modifications.
Sunday, April 3, 2011
I am rich with people. They are my renewable, sustainable resources, although I define those terms to mean they renew and sustain me.
This weekend, my husband and I went away for a Weekend with Peeps in Minneapolis and northern Iowa. We did a few museums, wandered around the Upper Mississippi, nosed around the mill district by St. Anthony Falls along the old mills on the Minneapolis riverfront, drove by Lake Harriet, with its gracious homes and trails packed with families, ate at an old firehouse, and ended up in church in Cedar Falls, Iowa.
Most important, though, were the people with whom we shared these experiences—Shawn and Berit, two of my former students who graduated the same year and who make their livings as writers; Mary Kay and Will, design stars who moved to Minneapolis from New York several years ago and who share their expertise with me as I prepare another edition of the magazine textbook I co-authored; Elizabeth, another former student, who is now an Episcopal priest.
We shared talks about everything from magazine design to parenting to religion and politics to Native American art. The kinds of talks you can start in the middle because build on a deep foundation.
I am blessed with interesting people in my life, people I appreciate and respect, people who appreciate and respect me. People with whom hours disappear in thoughtful discussions, laughter, and shared memories.
So we returned home tonight fairly pooped, but thoroughly renewed, beautifully sustained.
Rich with people.