Is there a link between triple negative and inflammatory breast cancers?

A reader recently asked me about the connection between IBC and triple negative breast cancer (estrogen-receptor-negative, progesterone-receptor negative, and Her2-negative). The results are mixed.

According to the Inflammatory Breast Cancer Research Foundation, most cases of IBC are also triple negative, although I could find no citations to support that claim.

In recent research through the American Society of Clinical Oncology on women with TNBC, 12 percent of the women with TNBC also had IBC.

But, in a study in the journal The Breast 52 percent of the women with IBC were Her2 positive, which means they cannot be triple negative, as Her2-negative is the third part of that triplet. That leaves 48 percent who were Her2-negative, but they could have been any mix of estrogen and progesterone negatives and positive.

So, once again, the answer is that cancer is not one disease and may be as unique as out DNA. So, while there may be some connections between IBC and TNBC, it does not look like the two are inevitably linked.

Inflammatory breast cancer (IBC) can be difficult to diagnose, as it may show no obvious tumors. Its symptoms can seem like mastitis and some doctors may not recognize it as cancer. Instead, they prescribe antibiotics. Young women who are nursing can be at risk and should be aware that breast problems should be taken seriously.

The National Cancer Institute has a good overview of IBC.

I have had two good friends whose diagnosis of IBC required them to virtually force their doctors' hands to have them tested. Both are smart, professional woman. One is a doctor herself. Yet their doctors did not take their symptoms seriously. Both were finally diagnosed and, because they lost so much time arguing with their doctors, their cancers were advanced and required aggressive treatment. The great news: Both are healthy and cancer-free. One is 11 years past diagnosis, and one is five years out. The first had both breasts removed. The second had aggressive chemo.

Tamoxifen leads to increased risk of hormone-negative breast cancer

Even though I had estrogen-negative (ER-)  breast cancer, my oncologist was insistent that I take tamoxifen.  I refused.  And I changed oncologists. The research below supports my decision.   

Women who took tamoxifen for at least five years had more than a four-fold increased risk of estrogen-receptor negative cancer in the second breast compared to women who were not treated with hormone therapy, according to research published in the journal Cancer Research. 

The drug reduced the incidence of estrogen-receptor-positive breast cancer by 60 percent, however.

Researchers studied 367 women with estrogen-receptor-positive cancer that had also spread to the second cancer.  The comparison group was 728 women with only a primary cancer.

Some  details:

• breast cancer survivors overall who took hormonal therapy were at a reduced risk of second breast cancer.

• use of tamoxifen for at least five years reduced the risk of both estrogen-positive  and progesterone-positive breast cancer.

• use of the drug for at least five years led to increased risk of both estrogen-negative  and progesterone-negative. 

Researchers said that the reason the risk increases with longer exposure is because more time is needed  “to foster an environment that promotes estrogen receptor-negative tumor growth.”   Essentially, they said, hormone therapy gives hormone--negative cells a growth advantage.

 

SOURCE: Li, Christopher I., Daling, Janet R., Porter, Peggy L., Tang, Mei-Tzu C., Malone, Kathleen E., “Adjuvant Hormonal Therapy for Breast Cancer and Risk of Hormone Receptor-Specific Subtypes of Contralateral Breast Cancer,”  Cancer Research, 2009 0: 0008-5472.CAN-09-1355. Published online August 25, 2009. 

 

 

Alternative Treatments Can Supplement Breast Cancer Care

As I have mentioned before, alternative treatments have been important to me in my battle with breast cancer—during and after treatment. I have to give a nod to Western medicine—research consistently shows the chemo is especially effective in combating hormone-negative breast cancer, including triple negative. l

But yoga, meditation, acupuncture, and proper diet have been equally important, maybe more so. Here’s what I have done to supplement Western treatments of surgery, chemo, and radiation.

Yoga: I am a late-comer to this wonderful Eastern practice. I began doing yoga after I finished treatment and I try to do it at least four times weekly. Before cancer (BC), I used to love my evening drink—or drinks. I needed them to relax me. No more. One yoga session relaxes me way more than alcohol ever did—and the benefits continue, whereas alcohol-induced relaxation turns to nervousness and sleeplessness. And alcohol is implicated in cancer. So if yoga does nothing more than reduce my drinking, it has provided a serious benefit. But it does much more—it’s kept my body, I think, in shape internally and externally.

Meditation. Closely tied to yoga, meditation calms me, helps me think clearly and focus, makes me sleep better, and in general gives me a flat-out Zen feeling. Ahmmmmmmmmm. I am especially sensitive to noise. Now, after meditation, if I hear a bothersome noise—a neighbor’s stereo, for example—I breathe deeply into the noise and eventually I am calmed.

Acupuncture. My acupuncturist is a wonder. I went to her before each chemotherapy session and she prepared me well and, I believe, reduced my nausea. Now, she has a perceptive link to my health that truly balances me. I can walk into Abby’s office feeling internally whacky and leave feeling truly connected to my health. I have gone to her for allergies, poison ivy, lingering colds, and anything else that has not responded to my normal ministrations. When she listens to my pulse, she hears everything from the fact that I have recently eaten nuts and not chewed them thoroughly enough to the stomach upset I hadn’t yet mentioned. I believe that, if I had a serious health problem, she would be plugged into it before I was.

Proper diet. A low-fat diet rich in vegetables and fruits has been found to be a solid cancer fighter. I start every day with a green drink and, usually, a smoothie with organic yogurt, blueberries, freshly ground flax seeds, and a banana. I end every day with a mixture of freshly juiced carrots, kale, cabbage, parsley and, occasionally, a beet. Throughout the day I get my minimum of five servings of fruits and vegetables and focus on antioxidants (blueberries) and cruciferous cancer-fighters (kale, cabbage, broccoli). I make sure I get enough Vitamin D--preferably through sun, and folic acid through vegetables and supplements.

The benefit to this diet is that my body mass index is at a healthy 23. Before cancer, I was at 29, just a snip under being obese.

Breastcancer.org has a good discussion on complementary and alternative treatments.

Italian trials show success with PET adjuvant therapy

American and European chemotherapy treatments use different drugs. So when I read about research done in Italy that showed significant response to a battery of chemo drugs, I was curious. The more I read about the study, though, the more I wondered. Look at the drugs used below. That’s a lot. A whole lot. Still, the response is good. But the toxic reactions are also significant.

Here’s the scoop:

Eight weekly cycles of cisplatin, epirubicin, and paclitaxel (PET) before surgery showed improvement in disease-free survival for women with triple negative breast cancer, in a phase II trial of women studied from 1999 through 2008. All had large ER-, PR-, Her2- tumors.

Seventy-four women received cisplatin (30 mg/m²) , (epirubicin 50 mg/m²), paclitaxel (Taxol) (120 mg/m²), with granulocyte colony-stimulating factor support. Within three weeks of chemo, all had surgery, primarily breast-conserving surgery. Forty-six of the women were in complete remission after surgery.

After that, those with fewer than four affected lymph nodes had combination chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. Those with more than four affected nodes had an additional four cycles of fluorouracil-epirubicin-cyclophosphamide (FEC) (epirubicin instead of methotrexate)

Forty-six of the women had pathologically complete response (pCR)—their cancer was effectively gone—after this regimen.

At 41 months, five-years projected disease-free survival (DFS) was 90 percent for the pCR women. For those without a pCR, the five-year DFS was 57 percent.

The 90 percent number, of course, is great. Still, that’s a lot of chemo. And 31 of the patients had severe neutropenia and anemia. Fewer than 20 percent had severe non-hematological toxicity.

The study was published in the July 2009 Annals of Oncology.

For comparison, in the United States, the current therapy consists of high-doses of cytoxan and adriamycin (AC) every two weeks; taxol is added (ACT) for those with affected lymph nodes. This offers a five-year overall survival rate of 83 percent for hormone-negative and a five-year disease-free survival rate of 73 percent. This research was published in the Journal of the American Mecial Association in 2006.

ACT was also found to improve disease-free survival for triple negative in a study published in the Journal of Oncology in 2009.

Karen Chiovaro 1956-2009

We lost another wonderful woman to triple negative breast cancer this week. Karen Chiovaro, my colleague and friend, died August 16. Karen was diagnosed in August 2007 and went through chemo and radiation, then breast reconstruction at the end of the process, in February 2008. The cancer returned shortly after that and she had aggressive chemo. My last email from her was her usual positive message, saying tests were good and that she was a candidate for PARP inhibitors. That was exactly a month before she died. PARP inhibitors do show great promise, but the research was a little too slow for Karen. Let’s support breast cancer research to encourage development of treatments for TNBC.

Karen was a vivacious woman with a true gift for life. She started her career as a school teacher, then moved into the production department at Meredith Corporation, where I met her. She ultimately became Senior Director of Production/Advertising for Meredith. Karen often visited my classes at Drake, walking students through an exercise in which they determined placement of pages in an actual magazine, usually Better Homes and Gardens.  It taught them a great deal about the relationship between advertising and editorial. She also was a valuable source, with her colleague Joanne Williams, on the production chapter of my magazine textbook, The Magazine from Cover to Cover.  And, in the brief period between treatment and remission, she even came to Drake to help interview staff members for the first issue of Think magazine, offering valuable expertise to the student who became production editor.

Karen’s obituary is here.

I will miss her.

Cancer Survivors: Get Behind Healthcare Reform

If I were looking for insurance right now, I would be largely out of luck. As a breast cancer survivor, I have that nasty pre-existing condition that allows insurers to deny me coverage or charge me so much I cannot afford it. When I turn 65, however, I will be eligible for Medicare, with no restrictions because of previous health problems. I will pay the same as other Medicare recipients for my care. Even Medigap policies—supplemental insurance that covers the 20 percent of health costs not covered by Medicare—cannot discriminate based on pre-existing coverage.

That, to me, is the biggest reason cancer survivors, their families and loved ones should support healthcare reform and should not be afraid of any expansion of government-run plans. At present, government-run healthcare allows us the treatment we need and views us as whole persons rather than pariahs who had the gall to get sick. Insurance companies too often look at us as expensive inconveniences. It is unconscionable that, in America, sick people go broke trying to pay for care or avoid needed treatments because their insurance won’t cover them. This is not the healthcare a great country deserves; it is the healthcare the insurance companies allow us to have.

Among the basic tenets of President Obama’s plan are the necessity of covering pre-existing conditions, protecting families from healthcare-related bankruptcy, and allowing people to maintain coverage if they lose their jobs. These are all essential to anybody who has had any type of cancer diagnosis. That big “C” can easily translate into a big “No” from big insurance.

The American Cancer Society supports healthcare reform for these reasons and for another biggee—prevention. The cost of a mammogram can cause a cash-strapped women to avoid caring for her health, which can put her life in jeopardy. In what world is that considered right?

DEATH PANELS

Aurghhhhhhhhh. It’s startling that this idea has gained the traction is has. The healthcare bill as it exists simply states that people have the option of end-of-life counseling. The word option means we can take it or leave it. And this means only things like living wills or an explanation of Hospice care. My husband and I already have living wills—we got them before I even got sick. We do not want to be kept on life support if our lives are essentially over—and we do not want our kids burdened with that decision.

Interestingly, Republicans supported this option in the 2003 Medicare prescription drug bill. Now, they are ranting about pulling the plug on Grandma. Is that politics or principle? Well....

One conservative, however, David Brooks of The New York Times, said, on today’s Meet the Press, "the crazies are attacking the plan because it will cut off granny. That is simply not true, that simply is not going to happen." On Friday, on PBS’s News Hour, Brooks said, “But it's about having serious discussions about care at the end of life. And we're going to have to have those discussions. So, in some weird way, I'm pro-death panel. I want to have those discussions, whether it's one-on-one or just as a society."

Be assured that death panels are not going to come to the chemo ward and tell us we’re all useless and not fit to live. A wise doctor, however, might give us some counseling about how to face the end of life. Death is going to happen to all of us, although most people avoid even thinking about it. Once you’ve had cancer, though, the reality of death is embedded in your consciousness. Still, are we really ready to face it? Do we know what Hospice offers? Do we understand what a living will is and what it means? Have we made provisions that mean we accept the responsibility for what happens at the end of our lives, rather than foisting that on our children or grandchildren?

Healthcare reform, as I see it, is about fairness. I am more invested, I suspect, because of the many people I know struggling with cancer. Fighting the disease is enough. We should not also have to fight our insurance companies. Let's level the playing field and truly give patients the rights they need and deserve.

Is HRT safe after a triple-negative breast cancer diagnosis?

I got a question from a reader about taking hormone replacement therapy after a triple-negative breast cancer diagnosis—she is five years post-diagnosis disease free. (Yea for her.) I cannot find any research on this specific issue, but I did find a few related studies. Some of you might have similar questions, so I am posting this for others who might be in this situation.

• Some cases of HR- recur as HR+. Research on this was published in the Annals of Oncology. It was a pretty small sample, though—only 40 women initially.

• Estrogen can be a factor in the earliest formation of hormone-negative disease, according to research in the Journal of Steroid Biochemistry and Molecular Biology.

• The association between HRT use and breast cancer was the same for TNBC as for other forms of breast cancer in another study in the Annals of Oncology.

• Oral contraceptives were associated with a higher risk of TNBC in a study published in the journal Cancer Epidemiology, Biomarkers and Prevention.

I would suggest trying alternative treatments such as acupuncture, yoga, and meditation. Also, watch your diet--eat lots of vegetables and fruit, reduce fats, processed carbs (sugar, white flour), caffeine, and alcohol. These will also help you fight cancer--an added bonus--and lose weight, which can reduce menopausal symptoms. Also, make sure you get enough calcium and vitamin D. I had success with evening primrose for hot flashes.