Genetic Profile Helps Define Links Between TNBC and Women of African Descent

ScienceDaily (Oct. 28, 2012) — For the first time, researchers have provided a direct comparison of gene expression profiles from African-American and East African breast tissue samples, according to results presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, held in San Diego Oct. 27-30, 2012.

The research, which began at the University of Miami in Florida and continues at the Translational Genomics Research Institute (TGen), should expand researchers' understanding of breast cancer across different ethnicities. This knowledge may lead to new preventive, predictive and treatment measures, according to Lisa Baumbach-Reardon, Ph.D., associate professor in TGen's Integrated Cancer Genomics Division in Arizona and director of TGen's DNA Diagnostic Laboratory in Cancer Genomics.

Epidemiologic evidence indicates that breast cancer is the second-leading cause of cancer death among African-American women. Compared with Caucasians, African-Americans have a 20 percent higher mortality rate.

"Ethnic-specific differences exist in genes expressed in breast cancer tissue across ethnicities," said Baumbach-Reardon. "Understanding significant ethnicity-specific differences will help us to better understand how and why breast cancer differs across different ethnicities and will ultimately help us to translate this knowledge into clinical practice."

Researchers analyzed archived breast cancer pathology samples obtained from either the University of Miami or the Nairobi Cancer Registry. Forty-seven breast cancer samples came from Kenya. After reanalysis, the researchers confirmed that 29 of the Kenyan cases were triple-negative breast cancer; a high percentage of these cases were in an advanced stage and were high-grade.

"It is known that in this African region, breast cancer presents as an advanced-stage disease, composed mainly of poorly differentiated cancers that are less likely to be hormone-responsive (i.e., triple-negative breast cancer)," said Baumbach-Reardon. "This is very similar to the presentation of African-American women with breast cancer in the United States."

Initial data analyses indicated there are gene expression differences within several key pathways, including signal transduction in the AKT signaling pathway, according to Baumbach-Reardon.

She and her colleagues also presented data on chromosomal aberrations and variants in a subset of the Kenyan samples.

The researchers do not yet fully understand why triple-negative breast cancer is overrepresented in women of African descent, although it is clear that multiple factors play a role, according to Baumbach-Reardon.

Radiation Therapy NOT Tied to Increased Risk of Heart Problems

Boston, October 29, 2012—Breast cancer patients who receive radiation treatment do not have a higher risk of long-term cardiac morbidity when compared to patients undergoing modified radical mastectomy (MRM), according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 54th Annual Meeting. This is the first study to document comprehensive, late cardiac outcomes 25 years after breast cancer treatment.

The study reviewed 247 stage I-II breast cancer patients who were enrolled in the National Cancer Institute (NCI) Breast Conservation Trial from 1979 to 1987 and found that 102 were alive 25.7 years after treatment. Fifty of those patients participated in this study, 26 of whom underwent breast conservation therapy (BCT) using radiation and 24 of whom underwent MRM. Patients were evaluated based on a detailed cardiac history, exam, cardiac labs and 3T cardiac MRI (CMR) to assess anatomic and functional abnormalities, as well as a CT angiogram to evaluate for stenotic coronary disease and determine if there was a high coronary arterial calcium score (CAC) for atherosclerosis. Imaging was assessed by a single experienced cardiologist blinded to each randomization arm.

Patient characteristics, exam findings and lab results were statistically similar for patients treated with MRM alone and those treated with BCT using radiation therapy, although BCT patients had somewhat lower rates of diabetes at 3.8 percent versus 12.5 percent for MRM patients. Systolic blood pressure rates were 127mm Hg versus 139mm Hg for BCT and MRM patients, respectively. Radiation treatment on patients’ right versus left breast showed no difference in the relevance, severity or distribution of atherosclerosis for BCT patients, including the left anterior descending coronary artery, which is in close proximity to the chest wall and received the highest radiation dose.

Using the Framingham model to assess a patient’s potential risk of developing myocardial infarction (MI) within 10 years of diagnosis and treatment, the study found similar rates between groups—the risk was 5.1 percent for BCT patients and 5.7 percent for MRM patients. Two MRM patients had a prior MI and one had heart failure. Diastolic function, including peak filling rate and diastolic volume recovery, was similar for both patient groups. Other similarities in the CMR findings included peak mid-wall strain and chamber mass, volume and function. The median coronary arterial calcium score (CAC) was similar in both groups at 25 for BCT patients and 0 for MRM patients, which are both in the normal range. No patients exhibited myocardial fibrosis, and one patient in each group experienced pericardial thickening. Among BCT patients, cardiac structure and function were similar for right- or left-breast tumors. BCT patients underwent radiation doses of 45 to 48.6 Gy to the whole breast, with a 15 to 20 Gy boost to the tumor bed. The study authors did find that visible atherosclerosis occurred somewhat more often among those receiving chemotherapy for both MRM and BCT patients.

“Over the past two decades, radiation therapy has become more precise and safer with modern techniques,” said Charles B. Simone II, MD, lead author of the study and a radiation oncologist at the Hospital of the University of Pennsylvania in Philadelphia. “We are pleased to find that early stage breast cancer patients treated with modern radiation therapy treatment planning techniques do not have an increased risk of long-term cardiac toxicity and that breast conservation therapy with radiation should remain a standard treatment option.”

The abstract, “Cardiac Toxicity is Not Increased 25 Years After Treatment of Early-stage Breast Carcinoma with Mastectomy or Breast Conservation Therapy from the National Cancer Institute Randomized Trial,” will be presented in detail during a scientific session at ASTRO’s 54th Annual Meeting at 11:00 a.m. Eastern time on Monday, October 29, 2012.

ASTRO’s 54th Annual Meeting, held in Boston, October 28 – 31, 2012, is the premier scientific meeting in radiation oncology and brings together more than 11,000 attendees including oncologists from all disciplines, medical physicists, dosimetrists, radiation therapists, radiation oncology nurses and nurse practitioners, biologists, physician assistants, practice administrators, industry representatives and other health care professionals from around the world. The theme of the 2012 Annual Meeting is “Advancing Patient Care through Innovation” and examines how innovation in technology and patient care delivery can lead to improved patient outcomes. The four-day scientific meeting includes six plenary papers and 410 oral presentations in 63 oral scientific sessions, and 1,724 posters and 130 digital posters in 18 tracks/topic areas.

ABOUT ASTRO
ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit www.rtanswers.org. To learn more about ASTRO, visit www.astro.org.

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Surviving TNBC Featured on WHO-TV

 WHO-TV in Des Moines, Iowa, recently did a story on me and my book, Surviving Triple-Negative Breast Cancer.  Check it out.  It was a fabulous experience for me—the reporter was exceptionally well prepared and asked impressively intelligent questions.  The photographer was so involved that he suggested using the notebook I kept while undergoing treatment, specifically to show the phrase, "Patricia, it's not that bad,"which is what the doctor told me when she called to tell me it was cancer.  I blessed that woman on a regular basis for giving me a positive outlook on my treatment and as I say in the book, "it's not that bad" became my mantra.  Anyway, here's the story, including way too much footage of my bald head.  Both the reporter, Erin Kiernan,  and photographer, Mike Borland, are graduates of Drake University's School of Journalism and Mass Communication, where I spent most of my professional life.

Yes, losing weight and keeping it off is hard.

I am filling out a survey today for the National Weight Control Registry.  I have done this for five years, ever since I dropped 50 pounds through diet and exercise and the wisdom of one of the biggest extravagancies of my cheapskate life—hiring a personal trainer.

There was a little bump in the road nine months after I started on my healthy regimen—breast cancer—but I remain convinced that it was far less serious and my response to treatment far easier because I had a healthy body going in.

I have kept almost all the weight off—I regained about ten pounds two years ago on a lovely tour of the South, when I had grits and gravy and white sauce—usually all at once.  And I cannot get rid of that weight.  Just cannot.  I remain active, with a healthy diet and only a few falls from the low-fat wagon (Mexican food and French fries are my downfalls).  I lose three or four pounds but it comes right back.

I appear to have no margin of error here.  I can watch my diet like a healthy hawk (no mice or carrion) all week and then we go out on Friday night and—whop—my weight pops up and stays there for days.

My husband says I should not weigh myself everyday, but I disagree.  I think that scale keeps me honest and is the reason I have done as well as I have.

Most people who lose weight regain everything they lost, so keeping my added weight at ten pounds is better than nothing.  And I have vowed not to buy larger clothes.  Wearing tight jeans helps me decide to have a salad instead of the chimichanga I really, really, really want.

But it is a struggle, and every time I write in this blog or elsewhere about how important it is to maintain a healthy weight—for TNBC, all forms of breast cancer, and a multitude of other diseases—I feel a little person on my shoulder saying, "But it is hard. Acknowledge that it is hard."

It is hard, but it is also important.  Filling out the form for the weight loss registry is probably the most helpful thing I do in terms of keeping my weight down.  In order to be a member of the registry, you have to have lost at least 30 pounds and kept it off at least a year.  Remaining a member of this group has become extremely symbolic to me—sort of a metaphor for my health.

And I do love fitting into smaller clothes.  Although women's sizes are just nuts, so I am not sure what size I actually wear. but that's another post.

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Obamacare and Cancer Patients

We have heard so much rhetoric about the Affordable Care Act, or Obamacare, that I would like to once again clarify some of the provisions in the bill.  Gov. Romney has said on multiple occasions that he would repeal the bill, and I think it is essential for all of us who have walked the cancer road to understand what that means. He has said he will keep some of the most popular provisions, but I worry what will happen when this all again becomes a political football.  What gains would we lose? How long will it take to makes changes?  What happens in the meantime?  The key points of the bill as it now stands, especially for those of us who have had cancer:

It outlaws discrimination because of pre-existing conditions. The Big C makes you quite an unpopular risk for Big Insurance. This bill changes that. Starting immediately, individuals without insurance and with a preexisting condition will have access to insurance. Starting in 2014—too long in my estimation—that applies to all individuals with insurance.  

It provides a cushion for those of us with high health costs.

• Beginning immediately, it limits the ability of insurance companies to charge higher rates because of health status.

• In January 2014, it will prohibit individual and group plans from placing annual limits on coverage.

• It prevents insurance companies from canceling your policy for any reason other than fraud.  And it has happened that companies have cancelled the policies of cancer patients.

It helps those over 65 with high prescription medicine expenses by reducing the “doughnut hole,” an odd little Medicare glitch that means that once seniors have spent $2,830 on drugs, they must cover the full cost of their medicines until their out-of-pocket expenses have reached $4,550.

This is not a budget buster. The Congressional Budget Office says the bill will reduce the deficit by reducing overall healthcare costs. This is a non-partisan group that took into account all aspects of the bill.  This is a complex issue, but the bill operates as a whole, cutting costs in things such as Medicare and Medicaid fraud and, yes, relying on everybody to be in the pool through the individual mandate.  The fact is that, without the bill, our healthcare costs are already draining our economy.  Throwing this back into the political arena could be a costly gambit.

For a complete analysis of the bill, check out the Kaiser Family Foundation’s summary.

Weight lifting and stretching best for lymphedema

NEWS RELEASE

COLUMBIA, Mo. –Nearly 40 percent of breast cancer survivors suffer from lymphedema, a chronic condition that causes body limbs to swell from fluid buildup, as a result of lymph node removal and radiation therapy. A cure for lymphedema does not exist, so individuals with the condition must find ways to manage the symptoms throughout their lifetimes. Now, a team of researchers and clinicians working with a University of Missouri lymphedema expert has found that full-body exercise and complete decongestive therapy (CDT) are the best ways for patients to minimize their symptoms and maintain their quality of life.

“There’s a sense of empowerment—of autonomy—that comes from meeting the challenge of living with lymphedema,” said Jane Armer, an MU nursing professor. “Some breast cancer survivors say that they’ve become a new person after cancer because they met a challenge, and they like the stronger person they’ve become. The challenge of lymphedema is similar. It’s something that is pervasive in every part of life. It takes problem solving and persistence to manage the condition without letting it interfere with their goals.”

Armer and her colleagues reviewed published research about lymphedema self-management in order to determine which practices were most effective in managing the condition. The researchers found that full-body exercise, such as weight lifting and stretching, was likely to be effective in minimizing lymphedema symptoms. In addition, the researchers concluded that complete decongestive therapy (CDT), a comprehensive treatment approach that incorporates skin care, exercise, manual lymphatic drainage and bandaging of swollen limbs, also helps patients effectively manage the condition.

“Previous research suggests that, the earlier the interventions, the better the outcomes,” Armer said. “If patients can learn how to successfully manage the condition early on, then they can continue those processes throughout their lives, and their outcomes will be better than those of individuals who resist participating in self-care.”

The research, “Self-Management of Lymphedema,” was published in Nursing Research.

A Low-Fat Cancer-Fighting Salad

My husband whipped up this yummy salad the other day and it’s about as tasty as it is healthy—and it is quite healthy.  

It mixes the ever-nutritious broccoli, a cancer-fighting cruciferous veggie, with chickpeas (aka garbanzo beans), which contain dietary fiber and folate, also good for reducing your risk of cancer.  

Add low-fat yogurt, red bell pepper and feta cheese, and you have a meal in a bowl, with only 122  calories per cup.  

Try it.  You’ll like it.  Find the recipe at Eating Well.

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Pregnancy Hormones Tied to Risk of Hormone-Negative Breast Cancer

Increased concentrations of the pregnancy hormones estradiol and progesterone were associated with an increased risk for hormone receptor-negative breast cancer diagnosed before age 50, according to the results of a nested case-control study presented at the 11th Annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research.  

The research was small—only 640 women, most of them with hormone-positive breast cancer—but the study might encourage continued research on the link between pregnancy and TNBC.  Samples were taken in the first trimester. Interestingly, the association was stronger for PR-negative tumors than for ER-negative.  And stronger for women under 50 than for those over 50.

"Pregnancy influences maternal risk for breast cancer, but the association is complex and the biological mechanisms underlying the associations are unknown," said Annekatrin Lukanova, M.D., Ph.D., associate professor at the German Cancer Research Center in Heidelberg, Germany. "Understanding the mechanisms underlying the protective effect of childbearing on cancer risk can form the basis for primary prevention of breast cancer."

Check out the abstract and more information here.

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Breast Feeding Reduces TNBC Risk

NEWS RELEASE

Breast-feeding reduced the risk for estrogen receptor-negative and progesterone receptor-negative breast cancer, according to results presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held in Anaheim, Calif., Oct. 16-19, 2012.

"We found an increased risk for estrogen receptor- and progesterone receptor- (ER/PR) negative breast cancer in women who do not breast-feed, but in women who have children and breast-feed, there is no increased risk," said Meghan Work, M.P.H., doctoral student in the department of epidemiology at Columbia University's Mailman School of Public Health in New York, N.Y.

Work and colleagues examined the relationship between reproductive risk factors -- such as the number of children a woman delivers, breast-feeding and oral contraceptive use -- and ER/PR-negative breast cancer. ER/PR-negative breast cancer often affects younger women and has a poor prognosis, according to Work.

The researchers used data from three sites of the Breast Cancer Family Registry, which includes women with and without breast cancer from the United States, Canada and Australia. This study included 4,011 women with breast cancer and 2,997 population-based controls.

The results indicated that having three or more children without breast-feeding was associated with an increased risk for ER/PR-negative breast cancer.

"Women who had children but did not breast-feed had about 1.5 times the risk for ER/PR-negative breast cancer when compared with a control population," Work said. "If women breast-fed their children, there was no increased risk for ER/PR-negative cancer."

Further, the researchers found that oral contraceptive use was not associated with ER/PR-negative cancer risk, with the exception of those formulations available before 1975. "These earlier formulations contained higher doses of estrogen and progestin than more recent versions," Work said.

These findings are in line with previous findings that have demonstrated breast-feeding benefit in triple-negative breast cancer. "This is particularly important as breast-feeding is a modifiable factor that can be promoted and supported through health policy," Work said.

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Cruciferous Veggies Like Broccoli Studied For TNBC Treatment

NEW RELEASE

Arlington, Va. — A new compound created from a rich source in vegetables including broccoli and brussel sprouts has been developed to combat triple-negative breast cancer (TNBC). This research is being presented at the 2012 American Association of Pharmaceutical Scientists (AAPS) Annual Meeting and Exposition, the world's largest pharmaceutical sciences meeting, in Chicago, Ill., on Oct. 14 – 18, during Breast Cancer Awareness Month.

TNBC accounts for approximately 15-20 percent of all breast cancer cases in the U.S. It is one of the most aggressive forms of breast cancer; it grows faster, spreads to other parts of the body earlier, is harder to detect on a mammogram and recurs more often. [Pat's note:  Again, TNBC can be aggressive, but this is not always the case.  And, unless it is paired with inflammatory breast cancer or very dense breasts, mammograms can spot it.]

Mandip Sachdeva, Ph.D. and Chandraiah Godugu, P.h.D. from Florida A&M University, in collaboration with Stephen Safe, Ph.D., from Texas A&M University, have evaluated the activity of novel C-substituted diindolylmethane (C-DIM) derivatives and demonstrated that they have superior anticancer activities. Sachdeva's study reveals that these synthetic compounds derived from diindolylmethane (DIM), commonly found in various types of cruciferous vegetables, can be used to treat several types of cancer, including triple-negative breast cancer. C-DIMs are also being investigated for their cancer prevention activity.

"Targeted treatment options for TNBC are limited; current treatments, such as infusions, result in poor patient compliance and increased toxicity," said Sachdeva. "We are confident that the compounds we are currently working with are an effective treatment for triple-negative breast cancer. These compounds are safer for the patient than current treatments available."

In contrast to existing anticancer drugs, the diindolylmethane compounds are orally active, so they could be available to patients in pill form and safe to take daily. When taken in combination with existing anticancer drugs, the diindolylmethane compounds can effectively decrease the number of treatments a patient receives.

PAT'S NOTE:  I always have kale and cabbage as part of my nightly vegetable juice—both are cruciferous vegetables.  Earlier research has pointed to these veggies as being helpful in fighting TNBC.  And they are good for us in general, so it seems an easy step to take.

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