Friday, May 28, 2010

Study Shows Race Not A Factor in ER-Negative Survival

African-American and white women from similar backgrounds treated similarly for estrogen-negative breast cancer had similar outcomes, according to research published in the May issue of the Journal of the American College of Surgeons. The bulk of the participants were from low-income neighborhoods in Louisiana and were treated at the Louisiana State University Health Services Center.

The five-year overall survival rates for both groups was 77 percent. Ten-year mortality rates were also similar, with 31 percent of the African-Americans dying in that time frame compared with 26 percent of the whites.

The study looked at 375 women with estrogen-negative disease who were treated from 1998 through 2008. Tumor size and grade; nodal involvement; and treatment were all similar. The whites had a slightly higher income than the African-American patients. African-Americans had a higher incidence of estrogen-negative (54 percent) than white women (39 percent.)

In previous studies, outcomes for African-Americans have been significantly worse than for whites. Some researchers argue that African-Americans might have a genetically different disease that responds poorly to typical treatments; others say the cause is socioeconomic. If the results of this study are borne out in future research, neither position may hold true. Race may be a factor in getting the disease, but not in overall reaction to treatment.

The study did not contain data on Her2, as it was not included in earlier data, so the results were not specific to triple-negative breast cancer.

Thursday, May 27, 2010

TNBC Vaccine Expected—in 10 Years!

Based on the success of a recently concluded Stage II clinical trial, Vaxon Biotech plans to start Stage III trials of Vx-001, a vaccine that may be effective against triple-negative breast cancer. Stage III trials for breast cancer will begin in 2012-13 and Vaxon Biotech expects that a vaccine might be available for triple negative in 2020. Gee whiz! Hurry up, guys.

Read the somewhat thick news release here.

Tuesday, May 25, 2010

Clarification of Basal-like and Non-Basal Hormone-Negative Breast Cancer

ER-negative breast cancer has a poorer outcome than the ER positive disease in the short term, but in the long term, ER-negative disease subtypes actually have a better prognosis, according to a recent study in PLoS Medicine. Triple negative breast cancers can be divided into basal and non-basal, with the basal subtype having a poorer prognosis.

Survival patterns were independent of treatment, the researchers say, indicating that the biology of the tumor is the essential prognostic factor.

Three ER-negative subtypes exist, termed basal-like, HER2-positive, and normal breast-like tumors. Basal-like breast cancer is commonly identified by a lack of ER and HER2 receptor expression and by the expression of either cytokeratin 5/6 or epidermal growth factor receptor (EGFR). Many, but not all, triple-negative breast cancers are basal-like.

Read the entire study here.


Blows FM, Driver KE, Schmidt MK, Broeks A, van Leeuwen FE, et al. (2010) Subtyping of Breast Cancer by Immunohistochemistry to Investigate a Relationship between Subtype and Short and Long Term Survival: A Collaborative Analysis of Data for 10,159 Cases from 12 Studies. PLoS Med 7(5): e1000279.doi:10.1371/journal.pmed.1000279

Our Last View of the Cabin

Last fall, we left the cabin in the snow. It is beautiful, no matter what season.

It Takes a Family to Build a Cabin

Our cabin is near the East Spanish Peak in far southern Colorado. We’re about 150 miles south of Denver and about 10 miles off I-25. If you are driving from Denver to New Mexico, just south of Walsenburg, look to the right (west) and you will see a wonderful mountain. That is the East Spanish Peak. We are at the foot of that beauty. Make sure you wave at me. We enjoy great tranquility there, with our nearest neighbors being my brother and his wife, who are there six months a year. We are there four months. Our nearest full-time neighbor is two miles away. We built the cabin ourselves. Below is an essay I wrote while we were building.

It Takes A Family To Build A Cottage

In the shadow of a Colorado mountain sits a simple country cottage built by an electrical engineer, an Internet technician, a sculptor, a reporter, a filmmaker, and a college professor. It’s a 480-square-foot monument to the family and to the tricky relationship between self-reliance and interdependence.

The cottage and the family are mine. The electrical engineer is my brother Ed, who was the cabin’s building contractor, the man who knew what he was doing and taught the rest of us how to do it too. He and his son the Internet technician built the cabin’s shell—exterior walls, floors, windows, roof, electrical system and plumbing. The sculptor and reporter are my daughter and son; they installed the insulation, drywalled, built the deck, and finished the interior. The filmmaker is my sister-in-law Gwyn; she helped finish and paint the walls inside and out, using sand from the nearby creek to create a textured finish. I am the college professor; I did a little bit of just about everything, even though at the time I was sure all of it was way beyond my capabilities

Like many professionals, I typically hire experts to do work around the house—painters, plumbers, electricians—and enjoy the pragmatic reward of somebody else’s job well done. Build an entire mountain home myself? Why? How? Huh? My brother, however, simply assumed I could do it. Or, more important, we could do it. So we did. Now the best part of my mountain getaway is the fact that every nail in every board was driven by somebody I love.

In many ways, the decision to build it was a natural for us. Our dad built our family home, in addition to much of its furniture. I remember him showing me how to use a hammer as we worked together in his basement workshop: Hold the handle at the very end, and use a broad stroke to slam the nail in. I still occasionally hammer like a girl—holding the handle in the middle and tapping the nail delicately—but I am getting the hang of this construction business.

At the cottage, Ed took Dad’s role, showing us all how to hook this to that so that it wouldn’t leak, burn up, blow away, or crumble. We were all cooperative students, although he had to remind me regularly of the builder’s adage, “Measure twice, saw once.” I needed to measure about sixteen times and, even then, I had to use creativity to make boards fit because I was inevitably off. Finally, I got new glasses and learned to take my time. The result is one of those learning experiences we appreciate a great deal after the fact.

I now know how to use a power saw (I even have my very own). I know how to hide drywall seams (even though you can still see many of them at night when the lights are on). I know how to build a deck (it’s actually a trapezoid rather than the standard rectangle, but it does the trick). I know the pleasure of watching my scholarly children turn into handy workers who get a serious kick out of constructing a wall. And I know how it feels to fall asleep at night exhausted by physical activity, but thoroughly fulfilled by the work.

We’ve spent four summers building the cottage, and by now it is a comfy little haven, with water, solar power, and a composting toilet. Along the way, both of my sisters, two more nephews, a niece, and her nephew have come along to help dig holes, install the woodburning stove, paint, and do generally whatever is needed. It has truly been a labor of family love.

Our parents instilled in my siblings and me a strong appreciation of nature and a desire to spend as much time with it as possible. They also taught us how to treasure one another, so that the idea of living in a family enclave on the mountain had a special appeal. The land where the cottage perches is our inheritance from our parents, who asked us what we wanted with the money they had saved through decades of frugal living. It was an easy answer: mountain land. So now I own a little corner of alpine paradise with Ed and Gwyn, who have a home—which they also built themselves—down the road.

The cottage started as a cabin, because that is what I intended to build, but along the way, that word began to feel inadequate; it no longer seemed to do the homey little place justice. So we promoted it to cottage status. Another few rooms—maybe eighteen or so— and perhaps it will be an estate. Whatever the name, the cottage formerly known as a cabin is actually an outgrowth of my family in more than its construction, because mementos from my various homes create the warmth of the place. The kitchen sink, chairs, and curtains came from my parents’ house; the dining table is one my husband built me for our tenth anniversary; and the coffee table was crafted from the wooden camping cooler my dad made more than fifty years ago. The biggest memento, though, is the cottage itself.

When we are on the mountain, we share most of our dinners with whatever motley collection of family members happens to be there at the time, in a wonderful throwback to communal living. We eat well—grilled steaks, homegrown salads, and homemade cookies—and we eat it in a setting of immense beauty. The cottage faces a 13,000-foot mountain across a meadow of timothy grass. Bears, deer, and coyotes eye us through the woods across the meadow; eagles glide above.

As my family relaxes on our slightly cockeyed deck enjoying the mountain greenery, we also look at our handiwork and share a deep satisfaction in the fact that the charming building by which we sit would not have existed without our labor. We also share the realization that the outside needs more permanent siding than the original plywood it still sports; that there’s no place to store all our tools; that the deck needs a rail; and that we will never be truly finished.

But that’s fine. Being finished is overrated. As it turns out, the product we have been creating here is not only a mountain home. Our shared sweat, exhaustion, and exhilaration have built more than a simple cottage in the shadow of a mountain; it has been one step in a major work in progress—our family.

Summer Hours

We’re headed to our wee cabin in Colorado for the summer, where we enjoy gorgeous scenery, fresh air, lots of animals, and thoroughly lousy Internet. We are 8000 feet up and I am pretty sure our connection comes up the mountain on a goat. So, I will reduce my posts significantly. I’ll resume my regular updates in the fall.

Thursday, May 20, 2010

Four Years Cancer-Free!

I have been felt up by two different doctors, had a mammogram and blood tests, plus an overall physical. No signs of cancer. Yea!!!!!!!!!! The mammo technician, though, gave me a scare, saying I have calcifications on the breast that had the cancer and doctors have been watching them because they can be a sign of early cancer. "Oh, great," I thought. I asked my surgeon who explained that I do, in fact, have calcifications in my affected breast, caused by the trauma it has gone through. "Most of the women I see have calcifications," he said. Mine are dispersed and stable--they have not changed in four years. Most important, they are not clustered. Clustered calcifications can be a sign of early cancer. According to my surgeon, though, they lead to cancer about five percent of the time, which means even if mine were micros, I still had a 95 percent chance they were not cancerous. Why did the tech mention that and why did she mention it the way she did? I swear, people need to think before they speak far more often than they do.

So I learned something new. I guess I have been oblivious to this, or else nobody thought to mention it to me. Whatever the case, four years cancer-free! Time to celebrate.

Wednesday, May 19, 2010

Markers Linked to Estrogen-Negative Breast Cancer

From a news release from the National Institutes of Health:

Scientists have identified a group of surface markers on cells linked to an aggressive type of breast cancer called estrogen receptor-negative cancer. In this preliminary study, estrogen-negative breast cancer developed when three markers, CD44+, CD49fhi, and CD133hi were present simultaneously on the surface of human cells taken from breast cancer patients and transplanted into a mouse; this is called a xenograft model. The scientists named these human cells with tumor-forming ability in mice, xenograft-initiating cells, or XIC. The research, conducted by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health, appeared online May 18, 2010, and in print June 1, 2010, in Cancer Research.

Surface markers, usually proteins, are visualized on many cell types using antibodies or other detection methods. To identify surface markers of estrogen receptor-negative breast cancer stem-like cells, the investigators tested different populations of human breast cancer cells for their ability to form tumors when injected into the fat pads of the mammary glands of mice with compromised immune systems. The various tumor cell populations were prepared by a technique called flow cytometry, in which distinct antibodies bind to specific cell surface markers, resulting in separate subpopulations of cells.
The identification of specific markers on cells that are associated with estrogen receptor-negative breast cancer is important because this type of breast cancer is more difficult to treat than estrogen receptor-positive breast cancer. Estrogen receptor-positive breast cancers may be treated with medications such as tamoxifen, which interfere with the activity of estrogen. But no targeted therapies are yet available for patients with estrogen receptor-negative breast tumors. These cancers are currently treated with chemotherapy drugs that are toxic to many cells, not just cancer cells, and which can be hard for patients to tolerate.
"We are excited but cautious at the prospect that the presence of the XIC markers on estrogen receptor-negative breast cancer cells may present a selective target for early detection imaging and for personalized therapy," said Barbara K. Vonderhaar, Ph.D., NCI scientist emeritus of the Mammary Biology and Tumorigenesis Laboratory, Center for Cancer Research. Read more.

Monday, May 17, 2010

My Belated Breast Cancer Anger

My acupuncturist told me today that I am tense. “What have you got to be tense about?” she teased. I immediately blamed the two articles I have due in the next week, plus the book I am writing.

But that did not ring true. I have spent my life fighting deadlines. Why would they start bothering me now?

Then, she said, “I think beneath this all there is some anger.”


Four years after my diagnosis, I am finally starting to get royally ticked off that I had cancer. One catalyst for this anger is that I came across the statistics from the National Cancer Institute estimating that 12.7 percent of all women will face breast cancer in their lives. So that means that 87.3 percent of all women will NOT face breast cancer.

After being positive and upbeat and shrugging this thing off for years, I am now starting to ask, “Why me?”

But why now?

I think I used all my positive energy to fight this thing and am only now feeling safe enough to get cranky about being selected for this elite club.

I am also facing my various doctors’ visits and mammograms and blood tests and all the whooha that we all deal with three or four times a year. I am tired of it. Tired of these regular worries about what might come. Are they going to find something this year? Has it come back after all this time?

Remaining positive is wearing on me. My husband says there’s no reason to think they will find anything this time—I am feeling fine and have no symptoms, yada, yada, yada. But, I tell him, if there is no risk, why do they do the tests at all?

And then that ticks me off. I remember so many friends who passed their tests and then ended up with a cough, a bump, a whatever, and the nasty stuff was back.

Yet, others catch something early and take care of it. I have talked with women who are years past a recurrence of triple negative, so a recurrence is not a death sentence.

Because my original diagnosis was not as frightening as most—a small tumor and no positive nodes—I sometimes have felt that I am not as justified in complaining as others. A friend recently told me that somebody had called hers a “fake cancer” because it was hormone positive and less than a centimeter. But, even though she has a better prognosis, she still faces the possibility of cancer returning. We all do. It happened once and we are forever on our guard.

That stinks.

Plus, I wonder, if this did come back, what would I do? Go through chemo again? I am truly not sure. I might just take my savings and hop a plane to travel the world.

In a few days I hope to post an update on being four years cancer-free. Still, I would rather not be dealing with all this at all.

I am pretty sure I am not alone in that feeling.

Tuesday, May 11, 2010

Asian Women Have Higher Rate or ER/PR-Negative

Women under 40 with Asian Indian/Pakistani roots have a higher rate of estrogen-negative and progesterone-negative breast cancer--both invasive ductal and inflammatory—than Caucasians. Researchers used data from the United States National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Cancer program to study 360,933 breast cancer cases diagnosed from 1988 to 2006.

Some stats on Asian Indian/Pakistani breast cancer patients:

• 16.2 percent were under 40 years old compared to 6.23 percents of Caucasians.

• They had more invasive ductal carcinoma and inflammatory cancer, and less invasive lobular carcinoma than Caucasians.

• Adjusting for stage at diagnosis, age, tumor grade, nodal status, and histology, Asian Indian/Pakistani women's survival was similar to Caucasians, while African Americans' was worse.

Read the abstract or get a PDF of the article here.

SOURCE: Kakarala, Madhuri, Rozek, Laura, Cote, Michele, Liyanage, Samadhi Brenner, Dean, 'Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S. - a SEER analysis', BMC Cancer , vol. 10, no. 1, 191+ (2010).

Latino Link to TNBC to Be Studied

The Fred Hutchinson Cancer Research Center has been awarded $10.24 million from the National Institutes of Health to lead a five-year look at breast cancer among Hispanic women. Among issues to be studied are the links to TNBC and overexpressing HER2 cancers in this group. Ten institutions across the country will contribute to the research. Read more on Medical News Today.

Older African American Women With TNBC Face Worse Odds

More research on how different triple-negative breast cancer can be for African-American women. In research published in Breast Cancer: Basic and Clinical Research (May 7, 2010):

• Within 23 months of diagnosis, 28 percent of African-Americans had some type of recurrence, as opposed to 19 percent of Caucasians.

• After three years, 64 percent of African-Americans had survived event-free (no other type of complications) and 76 percent had survived breast cancer-free, compared to 77 percent event-free and 92 percent cancer-free for Caucasians.

• African-American women 50 years old or older at diagnosis had significantly worse survival statistics than Caucasian women in the same age group.

The researchers, from the University of Tennessee Health Science Center in Memphis, and the Boca Raton Comprehensive Cancer Center Boca Raton, Florida, write:

Overall, there is a trend towards lower survival for AA women compared to Caucasians despite uniformity of tumor phenotype and treatment. The high early event rate, irrespective of race, underscores the need for effective therapies for women with TNBC.

SOURCE: Sachdev, Jasgit C., Ahmed, Saira, Mirza, Muhammad M., Farooq, Aamer, Kronish, Lori Jahanzeb, Mohammad, 'Does Race Affect Outcomes in Triple Negative Breast Cancer?' Breast Cancer: Basic and Clinical Research , vol. 4, 23-33 (2010).

MRI Can Detect Breast Cancer Spread Before Symptoms


A whole body MRI scan accurately detected breast tumors that had spread to the bone, even when there were no symptoms, offering a safe way to check patients, Indian researchers said on Thursday.

They said whole body magnetic resonance imaging or MRI -- which uses powerful magnets to create an image of the body -- should be the method of choice for checking to see if breast cancer has spread.

"When we use whole body MRI, it is a non-radiating tool. You are not giving radiation, which can be carcinogenic for the patient, and you are following them up very effectively," Dr. Joshita Singh of the Deenanath Mangeshkar Hospital and Research Center in Pune, India, who led the study, said in a telephone interview. MORE.

Wednesday, May 5, 2010

Taxanes plus Avastin Successful Against Triple-Negative

In research on mice with cancer cells nab-paclitaxel plus bevacizumab (Avastin) reduced tumor size by 100 percent, according to research presented at the meeting of the American Association for Cancer Research.

The release, from Medpage Today:

WASHINGTON -- Researchers here say a combination of a taxane and the targeted biological agent bevacizumab might be effective against hard-to-treat triple negative breast cancer.

While many drugs target tumors that overexpress certain proteins, there are limited therapies for women who develop breast cancer that do not overexpress estrogen, progesterone, or HER2 genetics, according to Sophia Ran, PhD, professor of medical microbiology, immunology, and cell biology at Southern Illinois University School of Medicine in Springfield.

Ran and colleagues told attendees at the meeting of the American Association for Cancer Research that they tested the use of paclitaxel protein-bound particles for injectable suspension -- nab-paclitaxel (Abraxane) -- by itself or in combination with bevacizumab (Avastin).

She said that nab-paclitaxel could reduce tumor size, but the addition of bevacizumab had additive and synergistic impacts on the tumors in animal models of triple-negative breast cancer. MORE.

Sunday, May 2, 2010

Smokers Face Higher Risk of Breast Cancer Recurrence

Survivors of early stage breast cancer who smoke after breast-conserving surgery—a lumpectomy—face a greater risk of developing a new second cancer than women who did not smoke (25 percent versus 9 percent). Smokers were also more likely to devlop cancer in the other breast than non-smokers (13 percent versus 8 percent). Results were correlated 15 years following treatment and were independent of other factors such as age, family history, hormone receptor status, and HER2/neu status.

Researchers from The Cancer Institute of New Jersey (CINJ) studied 796 self-reported smokers who received breast conserving therapy between 1975 and 2007 at Yale University School of Medicine. According to a news release from The CINJ:

Women who survive early-stage breast cancer and smoke have an increased chance of developing a new second cancer in their other breast or elsewhere. Investigators from The Cancer Institute of New Jersey (CINJ) are releasing these findings at an oral presentation during the 92nd Annual Meeting of the American Radium Society taking place this week in Cancun, Mexico. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

It has been shown that women who survive breast cancer have two- to six-times increased risk of developing cancer in their other breast, compared with women who have never had breast cancer. In hopes of making second cancers less likely, researchers have studied risk factors that can be controlled, such as smoking, obesity and alcohol consumption. Conflicting results on this subject recently appeared in studies published in the Journal of Clinical Oncology and the American Journal of Epidemiology. MORE