Saturday, March 21, 2009

Choosing the Best Doc for You.

Doctors are a mixed bag and some are better than others.  That's just natural.  As the old joke goes:  What do you call the person who graduated last in his medical school class?  Doctor.

But you want the best person for you because cancer is a big deal and getting the right treatment is literally a case of life and death.  How to find the right healthcare team to walk this walk with you?  Here are some tips.

1. Trust your gut. If you don’t like the doc, he just might feel the same way, and that could affect your treatment.
2. Get the best care you can afford. If this means heading out of town, do it. Cancer is a big deal; it deserves the best docs. US News and World Report lists the top 50 cancer centers
3. Do your research. On the left, I have listed some top websites for breast cancer information. Spend some time with these excellent resources--you'll learn a great deal.

4. Ask questions. A good doctor will take time to answer them. My radiation oncologist even drew a picture for me, explaining how radiation works. More evidence that she was good. She spent more than an hour talking about all types of treatment with me and my husband. And she treated me like a smart adult who could understand her.
5. Write down the answers. I still consult my treatment notebook, in which I wrote what the doctor said—direct quotes in quote marks, journalist that I am. This comes in handy for follow-up research.
6. Call back with questions. This is your life. If things aren’t making sense the way they should, ask.
7. Respect even the worst doctors. First, respect breeds respect. Second, these folks spend their lives around cancer, so they deserve a break. That said, if they are not serving you well, go elsewhere.
8. Find a patient advocate. If you cannot wrap your head around this information, don’t try to go it alone. Better yet, go to a center that has a Nurse Navigator program—these people are trained to help you make sense of treatment. They ask the questions you don’t know to ask, and they understand the answers.
9. Get copies of all your reports, especially your pathology reports. This is how I found out what doctors said about me.

Tuesday, March 10, 2009

Oprah's Article on Triple Negative

O, the Oprah Magazine, ran an article on triple negative breast cancer a while back:

The Breast Cancer Nobody Is Talking About
By Mary A. Fischer
One virulent, fast-acting type of breast cancer attacks 
more than twice as many young black women as all other women.

In May 2006, as she was getting dressed for work, Lori Booker felt a small lump in her left breast. Only 32, she was concerned but thought it was probably just a cyst and made an appointment to see her gynecologist. With a demanding job as a computer teacher at a Chicago public high school, Lori missed a couple of appointments, and two months later, when she finally had her first mammogram, the lump had doubled in size. A biopsy came back with grim results: She had aggressive, advanced-stage breast cancer. Crying, Lori thought the lab must have made a mistake. "I'm too young for this," she sobbed. more.

Sunday, March 8, 2009

TAC Improves Disease-Free Survival for Triple-Negative Breast Cancer

What type of chemo works best for triple negative breast cancer? If it’s early stage but has progressed to the lymph nodes, docetaxel, doxorubicin, and cyclophosphamide (TAC) was the most effective according to research published in the March 2009  Journal of Clinical Oncology.

TAC also worked well for those with luminal B who also took tamoxifen.

(Most patients know doxorubicin as Adriamycin and cyclophosphamide as Cytoxin.)

Researchers assessed different types of breast cancer to determine their value in evaluating patients’ prognoses and their responses to adjuvant chemotherapy (chemo after surgery). The types they studied:

• triple negative (estrogen receptor [ER]–negative, progesterone receptor [PR]–negative, HER2/neu [HER2]–negative).

• HER2 (HER2-positive, ER-negative, PR-negative);

• luminal B (ER-positive and/or PR-positive and either HER2-positive and/or Ki67high);

• luminal A (ER-positive and/or PR-positive and not HER2-positive or Ki67high);
They studied 1,350 patients from the Breast Cancer International Research Group (BCIRG) 001 trial. Of these:

•14.5 percent were triple negative, with a three-year disease-free survival (DFS) of 67 percent;

• 8.5 percent were HER2, with a three-year DFS of 68 percent;

• 61.1 percent were luminal B, with a three-year DFS of 82 percent;

• 15.9 percent were luminal A, with a three-year DFS of 91 percent.

Judith Hugh, John Hanson, Maggie Chon U. Cheang, Torsten O. Nielsen, Charles M. Perou, Charles Dumontet, John Reed, Maryla Krajewska, Isabelle Treilleux, Matthieu Rupin, Emmanuelle Magherini, John Mackey, Miguel Martin, Charles Vogel, “Breast Cancer Subtypes and Response to Docetaxel in Node-Positive Breast Cancer: Use of an Immunohistochemical Definition in the BCIRG 001 Trial,” Journal of Clinical Oncology, 27 (8 ), 1168-1176. 2009.

Friday, March 6, 2009

Consider Signing Up for a Breast Cancer Clinical Trial: Here's How, one of my favorite sites, has important information on clinical trials for breast cancer:

Clinical trials are research studies in which people agree to try new therapies (under careful supervision) in order to help doctors identify the best treatments with the fewest side effects. These studies help improve the overall standard of care.

Today, fewer than 5% of breast cancer patients receive treatment for their disease in a clinical trial. Why? One factor is that information about current trials and how to enroll in a trial are often not well understood. In this section, you can learn more about what clinical trials involve and how to join one.

Wednesday, March 4, 2009

Cases of Hormone-Negative Cancers Decreasing

Good news for our daughters and granddaughters:

Women are increasingly more likely to have the less aggressive form of breast cancer, hormone-receptor-positive (ER-positive and PR-positive), with smaller tumors, according to research published in the March 2009 British Journal of Cancer.

Scottish researchers compared 420 tissue samples from 1984 and 1986 with 653 from 1996 and 1997. In that ten-year span, they found that the proportion of estrogen-positive cancers rose from 64.2 percent to 71.5 percent. More grade one tumors were also diagnosed.

The good news here is that these cancers are easily treatable, offering a more positive prognosis than estrogen-negative cancers.


Lifestyle changes could be one influence, as could better screening.  As usual, doctors say more research is necessary.   

Brown, SBF, Mallon, EA, Edwards, J, Campbell, FM, McGlynn, LM, Elsberger,B, and Cooke,TG, “Is the biology of breast cancer changing? A study of hormone receptor status 1984–1986 and 1996–1997, British Journal of Cancer (2009) 100, 807–810. doi:10.1038/sj.bjc.6604934

Urine test can show spread of estrogen-receptor-negative breast cancer

Breast cancer spread—especially of estrogen-receptor-negative, including triple negative—can be detected through a urine test. 

This is according to research published online in Proceedings of the National Academy of Sciences February 23.   The urine test can detect tumors that are about to metastasize because they go through a process also seen in the development of human embryos, called epithelial to mesenchymal transition (EMT).  Phew!   A protein called lopcalin 2 (lcn2)  triggers the EMT in breast cancer and can be detected in urine. So a simple urine test for lcn2 could potentially predict the spread of cancer.  Women whose cancer has spread have especially high levels of lcn2.

“Lcn2 is among the genes most highly associated with estrogen receptor-negative breast tumors,” researchers Marsha Moses, Jiang Yang and colleagues at Children’s wrote.

Lipocalin 2 has been licensed to Predictive Biosciences,  in Lexington, Massachusetts for development of clinical use, which means the test may eventually be available for consumer use, although the process from laboratory tests to doctors' use can be slow and cumbersome.


Jiang Yang, Diane R. Bielenberg, Scott J. Rodig, Robert Doiron, Matthew C. Clifton, Andrew L. Kung, Roland K. Strong, David Zurakowski, and Marsha A. Moses. Lipocalin 2 promotes breast cancer progression. Proceedings of the National Academy of Sciences, 2009; DOI: 10.1073/pnas.0810617106