Stress a Factor in Hormone-Negative Breast Cancer

Women with the highest level of stress are the most likely to have estrogen-negative breast cancer, according to researchers at the University of Illinois at Chicago, who presented their research at the American Association for Cancer Research conference on The Science of Cancer Health Disparities. Scientists surveyed 989 women with breast cancer about their feelings of fear, anxiety, and isolation. Those who identified themselves as having the highest levels of stress were 38 percent more like to have cancers that were estrogen-negative. And they were 18 percent more likely to have high-grade tumors.

Black and Latina women also had higher levels of stress than white women.

In a statement, lead researcher Garth Rauscher, Ph.D., associate professor of epidemiology, says researchers don't know why stress is associated with estrogen-negative and aggressive cancer:

"It’s not clear what’s driving this association. It may be that the level of stress in these patients’ lives influenced tumor aggressiveness. It may be that being diagnosed with a more aggressive tumor, with a more worrisome diagnosis and more stressful treatments, influenced reports of stress. It may be that both of these are playing a role in the association. We don’t know the answer to that question.”

Glucose test could detect TNBC in high-risk African-American woman

A release from the American Association for Cancer Research:

Test could detect breast cancers earlier in young, high-risk African-American women

WASHINGTON, D.C. — Certain cancer signaling pathways that are activated in aggressive cancer can be detected very early, even in precancerous cells, among young African-American women at high risk for breast cancer. This may allow for earlier detection and prevention of cancer.

However, the early activation of these pathways, which are linked to how the body's cells consume and break down sugar, also raise the concern that certain conditions such as gestational diabetes and prediabetes, where the body produces more sugar, might stimulate precancerous cells promoting a conversion into cancerous cells.

Victoria L. Seewaldt, M.D., presented these study results at the Fourth AACR Conference on The Science of Cancer Health Disparities, held Sept. 18-21, 2011, in Washington, D.C.

"We see a lot of very aggressive triple-negative breast cancers among young African-American women and a very high death rate, with only 14 percent alive at five years," explained Seewaldt, professor of medicine and co-director of the breast and ovarian cancer program at Duke University in Durham, N.C. "We wanted to figure out why this was occurring among these women."

It was already known that aggressive cancer cells actively consume glucose and produce lactic acid, even in the presence of adequate oxygen. Seewaldt and colleagues said this shift toward lactate production is called the Warburg effect.

"One of the hallmarks of really aggressive cancers is that they start taking sugar, breaking it down and turning it into energy," she said. "It becomes their primary source of energy and that allows the cancer cells to grow rapidly."

Although the Warburg effect is normally assumed to be a late event in breast cancer, previous research indicated that this process occurs early, even during cancer initiation, in high-risk African-American women. Because this process is occurring earlier, the researchers theorized that they could test for it in young African-American women as a method of breast cancer prevention.

Seewaldt and colleagues looked at two independent groups of 39 and 38 high-risk premenopausal African-American women. High-risk women were normally those women who had mothers or sisters who died from breast cancer at an early age, according to Seewaldt.

"We found that in a high proportion of high-risk African-American women these precancerous cells were taking in a high amount of glucose, and they also had activation of insulin signaling," she said. "In these women, we would worry that if they developed gestational diabetes that the condition could really stimulate precancerous cells."

Luckily, conditions like obesity and gestational diabetes can be avoided or treated, said Seewaldt.

"Exercise, weight loss and the diabetes drug metformin provide important opportunities for preventing aggressive breast cancer in African-American women. These are things where a community approach could really make a difference," she said.

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The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes 33,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowships and career development awards. The AACR Annual Meeting attracts more than 18,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes seven major peer-reviewed journals: Cancer Discovery; Cancer Research; Clinical Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Prevention Research. AACR journals received 20 percent of the total number of citations given to oncology journals in 2010.

Living with Metastatic Colon Cancer for 13 years

Suzanne Lindley, founder of YES, has been living with metastatic colorectal cancer since 1998. She blogs about it for Cure. Love the story! Thirteen is certainly a lucky number for her and her family.

Chemo anti-nausea drug may cause heart problems

Zofran, often given to patients undergoing chemotherapy, may cause a "potentially fatal abnormal heart rhythm," the FDA said in a safety announcement September 15. Those especially at risk include patients with underlying heart conditions (such as congestive heart failure or bradyarrhythmias), those with low levels of potassium and magnesium in the blood, and those taking other medications that may change the electrical activity of the heart. The FDA is requiring the manufacturer, GlaxoSmithKline, to test the safety of the drug's effects on heart rhythms. The FDA's recommendations to patients now on the drug:

Do not stop taking Zofran (ondansetron) without talking to your healthcare professional.

Discuss any questions or concerns about Zofran (ondansetron) with your healthcare professional.

While taking Zofran (ondansetron), your healthcare professional may occasionally order an electrocardiogram (ECG, EKG) to monitor your heart rate and rhythm.

Seek immediate care if you experience an irregular heartbeat, shortness of breath, dizziness, or fainting while taking Zofran (ondansetron).

Report any side effects you experience to the FDA MedWatch.

What About My Daughter?

When my grandson Eli was only a month old, my daughter got mastitis. It went away, but returned a few weeks later. In my narrow world, in which one-plus-one equals breast cancer, I quietly panicked. She was clear on the symptoms, which included fever and muscle aches that are not signs of cancer, so I relaxed. Now, seven months later, she continues to breastfeed and both she and Eli do it smoothly and both are fine. Adorable, in fact.

I never told my daughter of my fears, but she knows I am a world-class worrier where my children and grandchildren are concerned, so I suspect she knew that my intense concern about her mastitis was based on a broader fear.

Could she have breast cancer?

Having the disease myself is one thing. Having a child with the disease is a whole other horror, and a much bigger one. Like most parents, I would much rather be sick than have my child sick.

My worries are legitimate. The fact is, thanks to my bout with the disease, Ellen now has double the risk of getting breast cancer. I am the only person in my family with breast cancer, though, which I hope reduces her chances. And I do not have the BRCA genetic mutation, so I know I will not pass that on to her.

But hormone-negative breast cancer, the disease that found me, is more likely to strike young women like my daughter. And, while cases of breast cancer have dropped in general in recent years, instances of hormone-negative have remained steady or, in some studies, increased.

Breast cancer strikes randomly, often with no regard for risk factors or lack of them. Fewer than 10 percent of all breast cancers are connected to the BRCA mutations. And fewer than 15 percent of women who get breast cancer have a family history. I thought I was in a low-risk category, until I became a blasted statistic myself.

Statistics deal with generalizations—what happens to the “average” person in broad circumstances. Individual cases are ruled by a wide variety of variables, with the result being that people with little risk (me) get cancer, while those with increased risk (Ellen) often don’t. I have several friends whose mothers had breast cancer and who have lived in fear for years that they would get it as well, while I blithely moved along, sure I had no risk. They are fine. I got cancer.

My worries are intensified by the fact that cancer lurks in my family. I may have been the first with breast cancer, but both of my parents had other forms of cancer—my mother had pancreatic cancer and my father an early form of leukemia. My grandmother died of stomach cancer before I was even born, but the way my dad talked about it, I suspect it could actually have been cancer in one of those unmentionable “female” places.

To pile on the risks, my husband has had prostate cancer, a disease that killed his father. So,both of my kids face a risk of cancer of some sort. Still, my husband and I beat the bully and are fine. He is more than ten years past diagnosis and I am more than five years past. We like to joke that we are actually healthy people who just had a little cancer. I mean, we are both far more active than any of our friends. In the past five days, we hiked 11 miles in three different walks in the Colorado Rockies, climbing a total of about 3,000 feet. Not bad for a 65-year-old and a 73-year-old. I suspect our kids do not consider either of us as sickly.

And, even though three of my kids’ grandparents died of cancer, they all did so in their 80s, after living active, productive lives.

I am heartened by the fact that my kids’ lifestyles are, in general, healthier than mine was at their age, which reduces their risk. Both eat better. I was not a fan of vegetables until late in life, but both Ellen and Josh love their farmers’ markets and co-ops. Ellen is a vegetarian and both are excellent cooks and appreciate healthy fare such as veggie soups and salads.

Both are active—as I write this, Josh is out on a bike ride that will probably total 40 miles and include multiple steep mountain rises. Ellen not only keeps up with two kids under 25 months, but also regularly hikes around the Vermont countryside and kayaks on a nearby lake. I hope they don’t slow down the way I did in middle age. And I hope Ellen does not gain weight the way I did after menopause.

While I don't want them to live in fear, I do want them to be vigilant. Breast cancer has been mistaken for mastitis before, and early detection is important. Both my husband and I caught our diseases while they were highly treatable. Still, I would prefer my kids have nothing to detect.

Most important, I hope they take after my husband’s mother, who died quietly in her sleep at 98. Before that, she lived comfortably at home by herself and was cogent and alert and full of love for her children, grandchildren, great-grandchildren, and great-great grandchildren. Those are the genes I hope dominate my kids’ lives.

I hope, I hope, I hope.