Saturday, April 21, 2012

Let's Talk About Normal Pain After Breast Cancer Treatment


I’ve had lingering pain from cancer treatment—nothing horrible, but enough to cause me concern.  Recently, I heard from a reader who was worried about bone pain in the chest area—she was sure it was a recurrence.  I told her I’d had the same pain and it eventually went away, but she was worried until she had a bone scan that came back clear.

Bless our hearts, we all do this.  Feel a pain, panic, talk ourselves out of that panic, then back into it.  Get tested.  Regret the test.  Delight in the results.

You know the drill.  So I am starting a discussion about pain, in the hopes that we can share a bit of what we have been through and shed some light on what is normal after treatment.

About half of all breast cancer patients have pain following treatment.  

My pains:

• In the chest bone, most likely from radiation.  My surgeon told me not to worry unless the pain woke me up at night.  This never got that bad—in fact in came and went and was mostly a moderate and dull ache.  It has since gone—it lasted about three years. Of course, if you Google “bone pain in breast bone,” you will immediately get to a site dealing with cancer metastases.  Sheesh.  So don’t Google it.

• Around my surgery site.  Even after nearly six years, my surgery still hurts—sometimes a shooting pain, sometimes a dull ache, sometimes nothing at all.  The breast has nerves than can be cut in surgery; they will not recover.  This pain comes less often than it used to, but it still pops up.

Lymphedema, or pain in the armpit. I have only slight pain here—perhaps because I assiduously did exercises from Thriving After Breast Cancer by Sherry Lebed Davis. Still, this is common and normal.

Breastcancer.org has a good discussion on how to deal with pain related to cancer treatment. 

What’s important, though, is that you understand that some pain is natural and it does not mean that the disease is recurring.  And the more we share what we’ve been through, the more we understand our new normal.

Wednesday, April 18, 2012

Ten New Subtypes of Breast Cancer Defined


A large global gene study of breast cancer tissue has defined ten different subtypes of breast cancer, potentially expanding our understanding of the disease, its cause, and treatment options.  It also sheds some light on the nature of triple-negative breast cancer.

In the research, published online in the journal Nature, scientists studied tissue from more than 2,000 women diagnosed with breast cancer in the past ten years.  Their analysis led them to divide the tumors into at least ten different genetic variations, including:  

• Seven subtypes of estrogen-positive and Her2-negative , which comprised 70 percent of all cases.  These seven types differed from one another significantly, with widely varied prognoses—from 80 percent to 40 percent survival rates.

• Her2-positive, which included both estrogen-negative and estrogen-positive tumors.

• Breast cancers that are similar to those currently classified as triple-negative.
• Inflammatory breast cancer, which includes both estrogen-positive and estrogen-negative tumors, including triple-negative.
What does this mean to us?  It’s hard to know at this point, but connecting some triple-negative cases to Her2-positive or inflammatory breast cancers may help us understand why some TNBC cancers are more aggressive than others. And that might eventually lead to clearer prognoses.
This is but one study, though, and it is not likely to change how breast cancer is classified at this point.  But it could be an initial step toward a broader understanding of TNBC.

Monday, April 2, 2012

TNBC molecular differences key to hope for treatment

From a News Release from the Translational Genomics Research Institute (TGen)

CHICAGO -- Because cases of Triple-Negative Breast Cancer (TNBC) are so genetically different, whole-genome sequencing is needed to detect the subtle molecular differences that might point to specific treatments for individual patients.

Dr. John Carpten, Ph.D., head of the Integrated Cancer Genomics Division at the Translational Genomics Research Institute (TGen), will deliver that message along with other preliminary findings about whole-genome sequencing of TNBC at the American Association for Cancer Research (AACR) Annual Meeting 2012, March 31-April 4, in Chicago.

"Every TNBC tumor we interrogate is genomically unique," said Dr. Carpten, who is part of an unprecedented and ongoing clinical trial involving the whole-genome sequencing of 14 TNBC tumors. Whole-Genome Sequencing, spells out all of the nearly 3 billion DNA molecules found in human cells, allowing unprecedented scrutiny of patients' genetic codes.

Dr. Carpten will co-chair an AACR panel, Concepts and Challenges in Bringing Next-Generation Sequencing to the Clinic. Dr. Stephen B. Gruber, M.D., Ph.D., M.P.H., and the H. Marvin Pollard Professor of Internal Medicine at the University of Michigan will co-chair. Other panelists include Giselle L. Sholler of the Van Andel Research Institute and Victor E. Velculescu of the Johns Hopkins Kimmel Comprehensive Cancer Center. The panel is set for 10:30 a.m. EDT April 2 at Chicago's McCormick Place convention center.

TNBC is unlike the nearly 80-90 percent of other breast cancers, which are driven by the hormones estrogen (1), progesterone (2), or too many receptors of the HER2 gene (3). Testing negative for all three means the cancer is "triple-negative."

Estrogen- and progesterone-driven breast cancers can be treated with hormonal therapy, while the drug Herceptin (trastuzumab) targets HER2 receptors.

But there have been no sure-shot treatments developed for TNBC, mainly because these cancers display a startling lack of uniformity, or heterogeneity, in their molecular make up.

"Whole-genome sequencing is enabling us to zero in on the specific challenges presented with each individual TNBC tumor, advancing a 'personalized medicine' approach that helps guide the treatment of each patient," said Dr. Carpten.

Based on mutations uncovered by sequencing, physicians may recommend that their patients enter treatment protocols for either existing drugs or for new agents being evaluated in pharma-sponsored clinical trials.
Investigators are sequencing germline and tumor DNA to identify genomic alterations including point mutations, insertions/deletions and structural events such as translocations. RNA sequencing also is performed on the tumors, along with tissue from age- and ethnicity-matched normal breast controls, to obtain insights on gene expression differences.

This clinical study is being conducted in collaboration with US Oncology Research, with support from Life Technologies Corporation.

"This is among the largest studies of a single tumor type in which whole genome sequencing is being used to identify potential options for targeted treatment," said Ronnie Andrews, president of medical sciences at Life Technologies Corporation. "We are very pleased to help support this study, which is providing key insights into how sequencing can best be used in the clinic."

The theme of the 2012 AACR meeting is "Accelerating Science: Concept to Clinic," reflecting the strides and breakthroughs being made by cancer researchers and the impact they are making on global health. The conference will emphasize the synergy between basic, clinical and translational research that lead to effective cancer therapies and prevention strategies.