Thursday, April 29, 2010

Attitude and Appetite Can Help Survival

A woman’s quality of life—her physical well-being, mood, and appetite—can affect her response to chemotherapy and her overall survival. Researchers surveyed women with advanced breast cancer on details such as pain, nausea and vomiting, and mood; all women were being treated with cyclophosphamide, methotrexate and 5-fluouracil. Those who scored highest on a quality of life scale had higher rates of overall survival. The research was published in the British Journal of Cancer (online, April 13,2010).

Source: Lee, C. K., Stockler, M. R., Coates, A. S., Gebski, V., Lord, S. J. Simes, R. J., 'Self-reported health-related quality of life is an independent predictor of chemotherapy treatment benefit and toxicity in women with advanced breast cancer', British Journal of Cancer , vol. 102, no. 9, 1341-1347 (2010).

DCIS Plus IDC May Mean Less Aggressive Cancer

Several women I have talked with recently have had multiple tumors, with one being invasive ductal carcinoma (IDC)—cancer that has invaded the cell wall—and another being ductal carcinoma in situ (DCIS)—cancer that remains inside the cell wall. Research published in the British Journal of Cancer (online, April 27, 2010) shows that, when both IDC and DCIS are present, the cancer tends to be less aggressive, with a five-year disease-free survival of 97.4 percent versus 96 percent for IDC alone.

The two were more likely to co-exist in younger, pre-menopausal women and in those whose cancers are hormone-positive.

Research was done on 1355 women. Researchers speculate that the co-existence of DCIS and IDC may mean a distinct type of less-aggressive cancer.

Source: Wong, H., Lau, S., Yau, T., Cheung, P. Epstein, R. J., 'Presence of an in situ component is associated with reduced biological aggressiveness of size-matched invasive breast cancer', British Journal of Cancer, vol. 102, no. 9, 1391-1396 (2010).

Monday, April 19, 2010

Mutlivitamins Cause Breast Cancer. Wait, They Reduce the Risk. Stay Tuned


To take the multivitamin or to not take the multivitamin: That is the question researchers are still trying to answer.

New research on vitamins has offered conclusions that weren't crystal clear. But researchers generally recommend getting vitamins from foods, not supplements, to boost your health.

Vitamin supplements and cancer

A study done on women in Puerto Rico, presented Sunday at the American Association for Cancer Research, found that multivitamin and calcium supplements have a protective effect against breast cancer. But a large Swedish study in the American Journal of Clinical Nutrition found that taking multivitamin supplements may increase the risk of breast cancer. Read more.

I hate bras

I have never been a big fan of bras. Having pigeon breasts, that usually has been not a huge problem. After my lumpectomy for breast cancer, though, I am even less happy being confined by Lycra and spandex. Or, even cotton, which can squoosh just as well as its synthetic cousins. Breathable, my Aunt Fanny.

My lumpectomy left me with a few lingering after-effects, which the bra exacerbates. I am a little smaller on one side than the other—I got a nice little tuck on the left, so I am far perkier there than on the right. I therefore need specially fit bras, which cost a fortune and I hate to shell out ten bucks at Target for a bra, why would I want to give more than $50 for a customized titslinger? (Thanks to Bette Midler for popularizing Otto Tintsling, the fictional inventor of the bra.)

The scar also remains tender—nearly four years after surgery. It is even crankier during changes of weather. And wearing even a light bra is uncomfortable. Add to that some lingering neuropathy from radiation and my entire chest can be a little grumpy, as can its owner.

Even the straps, which I never can adjust properly, bug me.

This is less a problem in cold weather, when I can wear a comfy tank or camisole covered by a turtleneck and a sweater. In warm weather, though, I feel the need to be a bit more discreet. I am 64 after all, and nobody would get much of a kick out of seeing me let it all hang out. On cool spring and summer days, I wear a cami and a T-shirt under a cotton button-up and that looks fine. Tighter fashions and warmer days, though require a bit more titular support.

I've tried built-in bras but even the straps on those dig into my shoulders and often leave a red mark proclaiming, “Pat was uncomfortable for a long time today.”

I am glad I spend most of my time at home in front of the computer, as my Apple really does not care how I look or if she can see my nipples. And I can usually stand a bra for a few hours when I go out and act professional. But I take it off as soon as I can, and my breasts and I heave a sigh of relief. All three of us hate bras.

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Friday, April 16, 2010

Recap of TNBC Teleconference

I enjoyed the Triple-Negative Breast Cancer Teleconference yesterday through Living Beyond Breast Cancer. Below are some quick notes from that discussion. Check the LBBC site for a podcast and transcript. Neither is available yet.

From Dr. Rebecca Dent, MSc, MD FRCP(C). Assistant Professor, University of Toronto

• We used to talk about stages in breast cancer; now we look at the biology of the disease and tailor our treatment. Research on TNBC and Her2 have “fundamentally changed the way we see breast cancer.”

• TNBC is not one disease, but many. Some tumors are basal-like—in the basal layer of the breast. Some are connected to the BRCA gene. Some have neither of these connections.

• Basal-like tumors are likely to spread to the nodes even when they are small.

• Women with HR- tumors benefit more from chemotherapy than those with HR+.

• “We’re trying to come up with triple-negative treatments. We are making a lot of headway.”

• TNBC and HR2+ cancers benefit the most from the addition of taxanes to chemotherapy.

• Platinum-based chemotherapy has long been used for lung cancer might be more effective against TNBC and Her2+. These include Cisplatin and carboplatin.

• Avastin has shown success with metastatic breast cancer.

• If you have a pathologically complete response—no sign of cancer after treatment—your chances of surviving TNBC are as good as with non-TNBC.

• A lot of our data come from older treatments—CMF, sometimes AC. We might be seeing better responses with new treatment—AC, plus taxanes.

From Dr. Lisa Newman, Professor of Surgery and Director of the Breast Care Center for the University of Michigan in Ann Arbor, Michigan,

• We don’t know what causes TNBC or why some women get it. We do know that it is many different types of diseases.

• Risk factors associated with TNBC include being younger at age and African-American. TNBC tumors are also larger at diagnosis than non-TNBC—an average of 3 cm. as opposed to 2 cm.

• At present, we define this disease according to what it does not have—it does not have markers for estrogen, progesterone or Her2. We need to find what markers are present.

• Because African ancestry is a consistent feature in this disease, we might be able to identify TNBC better by studying people in their environments.

• African-Americans are less likely to be diagnosed with breast cancer at all. If they are, they are more likely to be younger at diagnosis, have larger tumors, and a higher likelihood of dying from the disease. There is also a higher incidence of male breast cancer among African-Americans.

Thursday, April 15, 2010

Join the TNBC Teleconference Today

Living Beyond Breast Cancer is offering a teleconference at noon EST today on triple-negative breast cancer. For more information, check out their website. The conference is free. Some details:

Speakers: Rebecca Dent, MSc, MD, FRCP(C); Lisa A. Newman, MD, MPH, FACS

Join Living Beyond Breast Cancer and The Triple Negative Breast Cancer Foundation for our next free teleconference, Triple-Negative Breast Cancer: Genetic Risk and Treatment Updates, from 12:00 p.m. to 1:15 p.m. Eastern Daylight Time (EDT) on Thursday, April 15.

Rebecca Dent, MSc, MD, FRCP(C), of Sunnybrook Odette Cancer Centre, will explore the latest research and treatment options for triple-negative breast cancer.Lisa A. Newman, MD, MPH, FACS, of the University of Michigan Comprehensive Cancer Center, will discuss various risk factors associated with triple-negative breast cancer, including gene mutation, age, race and ethnicity. She will also offer suggestions for how to possibly reduce your risk of recurrence by making lifestyle changes. More

Monday, April 12, 2010

Wide Disparities in How Women Are Treated for Breast Cancer


A global study of nearly 10,000 women with early breast cancer has found wide variations in how they were treated, despite international consensus on best practice, according to the May issue of the British Journal of Surgery.

Researchers from Europe, Japan and America compared 9,779 women with an average age of 64 from 566 study sites in Belgium, France, Germany, Greece, Japan, the Netherlands, the UK/Ireland and the USA.

"The primary aim of our five-year research study was to carry out an international randomised trial to evaluate the efficacy and safety of the breast cancer drug exemestane, alone or following tamoxifen" explains co-author Professor C J H van de Velde from Leiden University Medical Center in The Netherlands.

"However, because we had recruited a large number of patients, we decided that this also provided us with an invaluable opportunity to examine how different countries treat postmenopausal women with early breast cancer.

"The results of our study show wide international variations in the percentages of women who receive breast conserving surgery (BCS) rather than breast removal (mastectomy) and radiotherapy after surgery.

Key findings of the study included

  • 58% per cent of the women had T1 tumours (less than 2cm), 37% had T2 tumours (2-5cm) and 5% had larger/more advanced (T3/T4) tumours.

  • 47% of the women had axillary node-positive disease, where the cancer affects the lymph nodes.

  • The highest percentage of node-negative disease was observed in the countries with the highest percentage of T1 tumours – the USA, France and Germany.

  • In general, women with T1 tumours were more likely to receive BCS. However, despite the fact that T1 tumour rates were similar in the USA and France (74% and 76% respectively), 89% of T1 tumours were treated with BCS in France compared with only 55% in the USA.

  • Women with T2 tumours were more likely to receive a mastectomy than BCS, but this varied widely between countries, from 42% in France to 69% in the USA.

  • The overall mastectomy rate for all tumours was 44%, with the lowest rate in France (19%) and the highest rate in Greece (56%).

  • BCS was highest in women aged between 50 and 70 and mastectomy rates were highest in women under 50.

  • Despite international guidelines that radiotherapy should be part of breast-conserving therapy, France and Belgium were the only countries to report 100% treatment rates. The highest non-treatment rates were in Japan (where 14% of patients did not receive radiotherapy), the UK and Ireland (13%) and the USA (14%).

  • 39% of women received radiotherapy after a mastectomy and 93% of women received radiotherapy after BCS treatment.

  • Some 82% of patients underwent Axillary Lymph Node Dissection, ranging from 75% in the USA to 99% in the UK and Ireland.

"Our study showed that despite international consensus guidelines, there are wide global variations in the way postmenopausal women are treated for early breast cancer" concludes Professor van de Velde.

"We believe that there should be further efforts to ensure that women can all benefit from the most effective breast cancer treatment available, regardless of which country they live in."

The TEAM (Tamoxifen and Exemestane Adjuvant Multinational) trial covered nine countries: Belgium (414 women), France (1,230), Germany (1,471), Greece (207), Japan (184), The Netherlands (2,753), UK and Ireland (1,275) and USA (2,232).


A 20-minute podcast, produced to coincide with publication of the paper, can be accessed here.

The paper is free online.

TNBC Benefits from Platinum-Based Chemotherapy

Platinum-based chemotherapy can be more effective against triple-negative breast cancer (TNBC ) tumors, according to research published in the Annals of Oncology in 2008. While this is a few years old, I am highlighting it because the research is continuing and also because the entire article is now online.

Who was studied:

541 patients who had been treated between 1991 to 2006 at the Royal Marsden Hospital in London; 19 percent had TNBC. Because TNBC was not an identified disease in the early 1990s, tumors specimens were retested for estrogen, progesterone and Her2 status. Nineteen percent of the patients—103—were identified as negative for all three, making them triple-negative. Another 155 had locally recurring or metastatic cancer; of these 22 percent, or 34 patients, were TNBC.

The results:

• Response rates for neo-adjuvant chemotherapy (done prior to other treatment) were significantly higher for TNBC tumors (88 percent ) than others (51 percent).

• The 5-year overall survival (OS) for TNBC tumors following both adjuvant and neo-adjuvant chemotherapy. however, was lower — 64 percent compared with 85 percent for others.

• Five-year disease-free survival for TNBC tumors was also lower— 57 percent compared with 72 percent for others.

• Patients with advanced breast cancer had a better overall response rate—41 percent for TNBC tumors and 31 percent for others.

• Patients with TNBC tumors had a progression-free survival of 6 months compared with 4 months for others, although the overall survival was not significantly different between the two groups (11 versus 7 months).

Treatment consisted of:

5-fluorouracil 200 mg/m2 by daily 24-h continuous infusion via a Hickman line for 18 weeks with epirubicin 60 mg/m2 i.v. and cisplatin 60 mg/m2 i.v. both repeating three weekly (infusional ECisF) for six courses as part of the adjuvant TRAFIC trial or neo-adjuvant TOPIC trial. Carboplatin was substituted for cisplatin in the event of renal toxicity, peripheral neuropathy or persistent emesis. The carboplatin dose was calculated according to renal function with an area under curve (AUC) = 5.