Women with TNBC worry more, want more information

The good people at Living Beyond Breast Cancer have put numbers to what we all know: Women with TNBC worry a lot and we really, really want information. The study was presented at the 2014 San Antonio Breast Cancer Symposium. Says LBBC CEO Jean A. Sachs:

“ Women with triple-negative breast cancers are information seekers, as we can see from the thousands of interactions we have with them via LBBC sponsored webinars, community meetings, conference workshops and first-person blogs on LBBC’s website. And they’re frustrated that they don’t have more treatment options.” 

LBBC presented two studies at SABCS. The first was “Education and information preferences for women with triple-negative breast cancer: Should personal or medical demographic variables impact program tailoring?” It found that TNBC women "had a significantly stronger preference for information tailored to breast cancer subtype."

The second abstract,“Emotional/psychological characteristics of women with triple-negative breast cancer: Do socioeconomic, demographic, and provider variables impact emotional change from diagnosis to post-treatment?” concluded that:

 “Women with TNBC experience greater fear, anxiety, and worry than women with non-TNBC subtypes at all points from diagnosis though post-treatment. While women with all breast cancer subtypes report a reduction in negative emotion over time from treatment to post-treatment, this change is less profound in TNBC women and appears to be driven nearly entirely by concern about the disease. The marginal effect on change in fear with respect to income may reflect concerns about paying for care, and increased worry in women with small children may reflect concerns about prognosis. Most strikingly, cancer stage was the strongest modifier of emotional change: TNBC women at cancer stage >=2 showed the least decline in negative emotion compared to corresponding non-TNBC women. These data support the development of TNBC-specific interventions focused on these patients’ emotional needs during and after treatment.”

Reduced Dietary Fat Again Connected to Reduced Death Rates for TNBC

Women with early-stage hormone-negative breast cancer (negative for both estrogen and progesterone)  who reduced their dietary fat intake for five years following a diagnosis had a 56 percent reduction in death from all causes in comparison to those who did not modify their diets, according to 15 years of data as part of the Women’s Intervention Nutrition Study (WINS) presented at the 2014 San Antonio Breast Cancer Symposium.

This was an even better response than was seen in the original WINS report, published in 2006, after five years of follow up

“HER2 evaluation was not available when this study was conducted, but it is likely that a
substantial number of ER/PR-negative breast cancers were also negative for HER2, making them
triple-negative breast cancers, which generally have a poor prognosis,” said said Rowan Chlebowski, MD, PhD, medical oncologist at the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center.

"Our findings suggest that if a lifestyle intervention is to have long-term influence on clinical outcome, it must be a lifelong change rather than be a short-term alteration."

The WINS was a randomized trial of 2,437 women ages 48 to 79 years with early-stage breast cancer receiving standard-of-care treatments at 39 centers in the United States. Of them, 1,597 had ER-positive breast cancer, 478 had ER-negative breast cancer, and 362 had ER/PR-negative breast cancer. Within six months from diagnosis, all women were randomly assigned either to a dietary intervention group (975 patients, of whom 205 had ER negative cancer, and 147 had ER/PR-negative cancer) or to a control group (1,462 patients, of whom 273 had ER-negative cancer, and 215 had ER/PR-negative cancer).

Women in the study group were given a fat gram goal by centrally trained, registered dieticians implementing a low-fat eating plan, explained Chlebowski. The women underwent eight biweekly individual counseling sessions with subsequent contacts every three months. They self-monitored their fat/gram intake using a “keeping score” book. Fat intake was externally monitored by unannounced 24-hour telephone recalls performed annually.

The study group kept fat intake at about 20 percent of daily diet.  This meant eating more vegetables and fruit. Women who did best emphasized healthy fats such as olive oil, fish and avocados and also added exercise to their regimen.

After five years of dietary intervention, fat calories were lowered by 9.2 percent and body weight
was lowered by nearly 6 pounds in the intervention group, compared with the control group.

TNBC tumors should be tested for genetic mutations, research says

Most patients with triple-negative breast cancer should undergo genetic testing for mutations in known breast cancer genes, including BRCA1 and BRCA2, according to the largest analysis to date of genetic mutations in TNBC, published in the Journal of Clinical Oncology.

The study found that almost 15 percent of triple-negative breast cancer patients had harmful mutations in breast cancer-related genes. The vast majority of these mutations appeared in genes involved in the repair of DNA damage, suggesting that the origins of triple-negative breast cancer may be different from other forms of the disease. The study also provides evidence in support of the National Comprehensive Cancer Network (NCCN) guidelines for genetic testing of triple-negative breast cancer patients.

Recent studies have suggested that triple-negative breast cancer patients might harbor genetic mutations that make them more likely to respond to alternative treatments like cisplatin, a chemotherapy agent, or PARP inhibitors, anti-cancer agents that inhibit the poly (ADP-ribose) polymerase (PARP) family of enzymes.

In the current study, researchers sequenced DNA from 1,824 triple-negative breast cancer cases seen at 12 oncology clinics in the U.S. and Europe, as part of the Triple-Negative Breast Cancer Consortium.They found dangerous mutations in almost 15 percent of triple-negative breast cancer patients. Of these, 11 percent had mutations in the BRCA1 and BRCA2 genes and the rest had mutations in 15 other predisposition genes, including the DNA repair genes PALB2, BARD1, and RAD51C. No mutations were found in predisposition genes involved in other processes like the cell cycle.

The study also found that individuals with mutations in predisposition genes were diagnosed at an earlier age and had higher-grade tumors than those without mutations. The researchers used their dataset to assess whether the current screening guidelines would identify all the triple-negative individuals with mutations in the two most common predisposition genes, BRCA1 and BRCA2.

They found that the NCCN guidelines, which recommend screening when there is a family history of cancer or a diagnosis under age 60, missed only 1 percent of patients carrying mutations. In contrast, the UK’s National Institute for Clinical Excellence (NICE) guidelines, which use the probability of actually finding a mutation to determine who should be tested, missed 24 percent of mutation carriers. They suggested expanding the NICE guidelines for TNBC patients.

Source: The Mayo Clinic.

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For more details on triple-negative breast cancer, check out my book, Surviving Triple-Negative Breast Cancer.

miR-21 most dangerous in TNBC tumor environment

High levels of the microRNA miR-21 in the environment around a tumor, but not in the cancer cells, are associated with worse outcomes for patients with triple-negative breast cancer,   according to a study in The American Journal of Pathology.

miRNAs are short RNAs that modulate gene expression. In previous research, miR-21 was associated with poorer disease outcomes in cancers of the colon, pancreas, and breast. The goal of this study was to explore in greater detail the influence of miR-21 on TNBC outcomes, looking both at the amount and the location of miR-21 expression. The authors suspected that changes in the tumor's surrounding microenvironment could be even more important than changes within the cancer cells.

miR-21 expression was found in 42.8 percent of the 901 cases tested. Patients with TNBC with high levels of miR-21 in the tumor microenvironment faced outcomes three times worse than those with lower expressions or at other locations.  

Researchers say this emphasizes the need for genetic testing of TNBC tumors and could lead to targeted treatment for those with miR-21.

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For more details on triple-negative breast cancer, check out my book, Surviving Triple-Negative Breast Cancer.

Genetics Lead the Way to Targeted TNBC Treatment: 17q25.3

The q25.3 region of chromosome 17 may be another genetic marker that defines subtypes of triple-negative breast cancer and, therefore, could lead to the golden grail: targeted treatment, especially for those forms of TNBC linked to the BRCA1 mutation.  In research published in the journal Breast Cancer Research, 17q25.3 was detected in 86 percent of the mutated TNBC tumors.

This is significant because, as the researchers note, the BRCA1 mutation is closely linked to TNBC, with  as many as  90 percent of tumors with the mutation being triple negative.  This does not mean, however, that all TNBC tumors have the BRCA1 mutation.  In fact, only 10 to 20 percent of all TNBC tumors have the BRCA1 mutation.  I explain this link in my book on TNBC.

Identifying patients with the BRCA1 mutation will ultimately help select patients who could benefit from  selective treatments 17q25.3.   First, though, we need those treatments.  Baby steps, friends.  But at least they are steps.

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For more details on triple-negative breast cancer, check out my book, Surviving Triple-Negative Breast Cancer.

Protein Successfully Stops TNBC in Mice

A team at the University of Kansas School of Medicine has identified a potential target for treating triple-negative breast cancer: atypical protein kinase C signaling. In a recent paper, published in the journal Cell Death and Differentiation, Soumen Paul, Ph.D and his colleagues conclude that this finding holds "tremendous" promise for treating breast cancer.

The researchers analyzed tissue samples of breast cancer that had spread to the liver, lung and other organs and found that atypical protein kinase c lambda/iota, which is known to influence cell growth, was highly expressed and phosphorylated in metastatic breast cancers.

In tests conducted on mice, the researchers depleted the protein in a line of triple-negative breast cancer and found that this significantly slowed the breast tumor growth.

Previous studies have implicated the atypical protein kinase c lambda/iota in the other cancers, they say, but no prior study had indicated any role in breast cancer metastasis. 

"We have been able to show that this protein is highly expressed in metastatic triple-negative breast cancer, and when we are depleting it from triple-negative breast cancer cells, we found that the cancer cells are not metastasizing," Dr. Paul said. "The tumor growth is slowing down. This is giving us an opportunity for a targeted therapy."

The next step would be to begin clinical trials on humans, but that could be years away.

Source: The University of Kansas

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Genetic Screening Can Predict Breast Cancer Risk

Genomic sequencing might successfully identify women who would benefit most from breast cancer screening option such as mammography. And knowing their risk for breast cancer at birth may help women take measures to modify their non-genetic risk factors, such as diet and lifestyle, and lower their risk. All this from a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

“We need low-cost screening tools that can discriminate between women who will and won’t develop fatal breast cancer that are more effective than those currently available,” said Alice S. Whittemore, PhD, professor of epidemiology and biostatistics in the Department of Health Research and Policy at Stanford Cancer Institute in California.

“Previous studies using theoretical models have predicted that sequencing the genomes of women, ranking them by risk, and then targeting those at highest risk will provide little gain in cost-effective disease prevention,” she said. “However, our estimates suggest that preventive strategies based on genome sequencing will bring greater gains in disease prevention than previously projected. Moreover, these gains will increase with increased understanding of the genetic etiology of breast cancer,” she said.

Whittemore and colleagues used data from published literature on the frequency of 86 known breast cancer variants associated with breast cancer risk. They then developed a model to estimate a woman’s lifetime probability of developing breast cancer.

“Variance is a relative measure of the heterogeneity of breast cancer risks in the population,” Whittemore said. “The more genetic variants we discover, the more heterogeneous our genetic risks will be, and the more effective it will be to target those at highest risk.”

Knowing our probability of getting cancer also might change how we live our lives, said Weiva Sieh, MD, PhD, assistant professor and epidemiologist at Stanford and first author on this study. “If a girl knew, from birth, what her inborn risk was, she could then make more informed choices to alter her future risk by altering her modifiable factors, such as diet and lifestyle.”

Source: The American Association for Cancer Research

Five Things You Can Do Now To Reduce Your Risk of Breast Cancer

What can you do to reduce your risk of breast cancer?  These research-based tips can improve your breast health and make you feel better overall. An added benefit: you'll look better too.

1. Eat a plant-based diet of fruits, vegetables, seeds, nuts and whole grains.  Make sure you include five servings a day of fruits and vegetables. Your best best: cruciferous veggies such as cabbage, kale, broccoli, cauliflower, bok choy.  You can pack a lot of nutrition in a smoothie that takes about ten minutes to make.  Just blend a handful of kale, 1/8 a small cabbage, 2-3 carrots, 2-3 stalks of celery, and an apple, with some filtered water or all-fruit juice.  That makes enough for two, so you can encourage your partner's health.

2. Exercise at least a half an hour five times a week and do it consistently.  The more strenuous the better—running, race-walking, or boxing, for example—as long as your knees and heart and lungs can handle it.  Go for a mix of aerobic and resistance-training.  You don't need weights—sit ups and push ups will do.  And yoga is a great way to mix all-over toning with mental breaks. Try a yoga CD that takes 15 or 20 minutes first thing in the morning, before you even get out of the bedroom and get distracted.  Yoga classes are also a great way to socialize.  Walk outside as much as you can because it also reduces stress.  Amuse yourself by taking photos of your surroundings.

3. Lose weight.   Aim for the "normal" column of the body mass index.  A 5-foot, 5-inch woman who weighs 130 pounds has a BMI of 21.6, right in the middle of the healthy range.  If you eat healthy and exercise, you will naturally lose weight.  This is hard, I know. I lost 50 pounds nine years ago and it was the best thing I have ever done for myself.  I didn't dodge the cancer bullet, but I know my recovery was easier and faster because my body was geared up.  Start small and just keep at it.  Instead of going on a diet, change the way you eat so you pack your plate with plant-based foods and avoid unhealthy fats (in fried and processed foods, cookies, cakes, and other goodies.  Just switching to a smaller plate can help.

4. Limit alcohol to less than one drink a day.  Some experts say to cut it out completely.  Don't pitch the wine glasses, use them for all-fruit juice instead.  You can juice a watermelon, rind and all, put it in a fancy glass, and treat yourself.   Add some seltzer water to any old juice for extra sparkle.

5. Reduce toxins in your environment.  Add filters to your drinking water and your shower.  Use chemical-free cleaning supplies—you can do a lot with baking soda and vinegar.  Encourage your city and state officials to invest in low-pollution energy sources and to maintain clean water, free of agricultural and manufacturing run-off.  And, speaking of those drill bits, evidence is growing that dangerous fracking chemicals make their way into our groundwater—and even the best filter won't help keep them out.

Hope and TNBC: Now in Paperback

Remember when your doctor told you that you had breast cancer?

Oh, yes, you sigh.

And remember when your doctor told you it was an especially aggressive form called triple-negative, or estrogen negative?

Oh, yes, you shudder.

I suspect your reaction was like mine—confusion and terror.

Well, I was there eight years ago and now, look what I have done. I survived. Eight years!  I have seen the birth of two grandsons since then, started painting again, traveled all over the darn place, and just generally get up every day like a regular person.   

And the thing is, I am not unusual.  The majority of women with non-metastatic triple-negative survive and go on to live long, full, meaningful lives.

And that is one of the many messages of my book, Surviving TripleNegative Breast Cancer:  Hope, Treatment, Recovery, now in paperback.

Notice the emphasis on hope.  That’s because I know so many women are terrified at this diagnosis—they think they cannot survive.  And I understand that completely.  

When I was diagnosed, I went online—of course, isn’t that what we all do?  And what I found there terrified me—so many stories about this being an especially lethal form of cancer, about how aggressive it is, how the odds are against you.

The reality is far less scary.  Far, far less. It is true that the survival rates for the more common form of breast cancer—hormone-positive cancer—are better than they are for triple-negative breast cancer.  And it is true that metastatic TNBC can be touch to beat. But, still, I repeat, the majority of women with TNBC survive.  That has become my mantra. Repeat after me: The great majority of women with TNBC survive.  

In studies, as many as 90 percent of those with early stage TNBC survived.  That’s a great statistic.  Survival rates go down with higher stages, but even through stage 3, studies show that TNBC is highly survivable.  

So, through my book and my blog, I am trying to counter the gloomy prognosis that is often automatically connected with this disease by doctors, journalists, and researchers.  This is not a disease to take lightly—but in the great majority of cases, it responds to treatment.

I repeat, The great majority of women with TNBC survive.    

Here are some of the things I talk about in my book:

• I tell my story—briefly.  And I tell the stories of 11 other marvelous women who had estrogen negative or triple-negative and survived quite beautifully.  One was breast-feeding her son when she was diagnosed.  That son is now past 30.  Two had babies after treatment, one got married in her 50s, one is competing in triathlons.  One had two bouts of TNBC and has survived the second for ten years.

Wonderful women.  Wonderful stories.

• But the core of the book is in research—triple-negative breast cancer is now the subject of some important studies worldwide, and I share the results of that research.

• I explain the disease and what we know about risk factors.  I show you how to read your pathology report.  And I expand on treatment options.  Triple-negative responds well to chemotherapy, so most women have some form of surgery, chemo, and radiation.  Metastatic, or stage 4 TNBC, is hard to fight, as are all stage 4 cancers, but it is the focus of most of the current research, so I am hopeful we find a treatment soon.   

• And I talk about things we can control ourselves—diet and exercise.  And give some tips on how to maintain a healthy approach to both.  Plus, I offer the triple-negative breast cancer diet—a blueprint for healthy eating.

I approach the reader as a real person—I understand that she needs information and encouragement and perspective and, sometimes, a reason to laugh.   

I am a journalist and a college professor, so I applied the skills I learned as a teacher, writer, and researcher to this book.  Most important, I survived.  And you can do.

Surviving Triple Negative Breast Cancer can show you how, and can give you the hope—based on detailed research—you need.
 

Radio Frequency Technology Can Replace Getting Your Breast Wired for Surgery

The localization wire was one of the most outrageous aspects of my breast cancer surgery.  The thin wire is inserted into the breast through a needle to help mark the location of a tumor on the day of surgery.  In my case, the wire then was covered with a Dixie cup—yes, a Dixie cup—to protect it while I was wheeled toward surgery.  This was especially humiliating because I had the wire inserted in a clinic and then was then transported through a well-populated atrium to the hospital with that cup sticking out of my cup.  

Certainly, I thought, this isn't common.  Turns out it is and it is still happening.  (Without the extra cup, I hope.) But a team of docs at the University of Wisconsin-Madison are hoping to make some changes.

The team's solution: a system that replaces the localization wire with a radio-frequency tag that helps the surgeon track the tumor's location with greater precision.   

"It's not something I think I would wish on anyone," says Dan van der Weide, a UW-Madison professor of electrical and computer engineering. "It's stressful to place this wire on the day of a difficult surgery."

And to an engineer's eye, the localization wire creates all kinds of obstacles to the end goals of removing a tumor while preserving as much healthy breast tissue as possible. For example, the wire is inserted when the breast is compressed in a mammogram machine or under ultrasound guidance. If the mass or cancer is in the center of the breast, there may be a distance of more than two inches from that mass to the skin where the wire must exit.

"I get a 2-D picture of where  the wire is in the breast, but it's a 3-D event—and requires piecing the pictures together to find the cancer," says Lee Wilke, director of the UW Health Breast Center and a UW-Madison professor of surgery.

Even at best, the localization wire is simply marking one point along the boundary of the tumor, leaving it to the surgeon to figure out the rest of the picture. "The wire can be very biased, because it only comes from one direction," Wilke says. "It's been this way for more than 30 years."

One possible workaround is to implant a small radioactive pellet at the location of the tumor, then track it with a handheld radiation detector. But Wilke points out that cancer clinicians are already exposed to a lot of radiation, and putting them at even more risk obviously isn't good for anyone.

Radio frequency identification (RFID), a widespread technology with many applications in tracking and communication, offers a compromise.

Because the tag could be implanted while the patient undergoes a biopsy, it essentially eliminates not only the wire but also the entire localization wire-implant procedure, which, according to a news release, "can save up to $2,500 per patient."

My question:  $2500?  Is that what we were paying for that wire?  I wonder if I got charged extra for the cup. 

Source:  News release from the University of Wisconsin-Madison.

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A Prayer in Itself

This beautiful Vermont scene feels like a prayer to me—a thankful, hopeful moment with God.  Sometimes we think prayer has to be formal.  To me, just giving thanks for this and for all the beauty in our lives is the best prayer we can offer.

PHOTO BY PAT:  Warren, Vermont

To Joan Lunden: Most Women Beat TNBC

Joan Lunden is being treated for triple-negative breast cancer, according to People magazine.  It's the same type of cancer Robin Roberts has battled.  And, of course, me and many of those who read this blog.

She has started chemotherapy and has agreed to go public with her treatments, which I hope takes some fear out of the disease for others facing it.   I send her virtual hugs, but more important, I send hope. Even though this disease can be aggressive, it is not necessarily so, and the great majority of women with non-metastatic TNBC beat it.  

Go, Joan. 

  

Breastfeeding Reduces Risk of TNBC in African-American Women

[Information below is from Boston University and has been edited to eliminate misleading comments, such as that triple-negative breast cancer is automatically aggressive.]

African-American women who have had children and never breastfed appear to have an increased risk of developing estrogen receptor-negative breast cancer, including triple-negative breast cancer, according to a study published in the Journal of the National Cancer Institute.  

This is consistent with previous research that showed that breastfeeding reduced TNBC risk in all women.

Researchers combined data on breast cancer cases and controls from four large studies, including the Boston University Black Women's Health Study. The combined analyses included 3,698 African American women with breast cancer, including 1,252 with the estrogen receptor-negative subtype.

They found that women who had four or more births and had never breastfed any of their babies had a 68 percent higher chance of developing this type of cancer compared with women who had only one birth and had breastfed that baby.

African-American women are more likely die of breast cancer than white women, and are more likely to be diagnosed with triple-negative.

Although previous studies have shown that overall risk of breast cancer may be elevated during the first 5 or 10 years after giving birth with a subsequent reduction in risk, this study suggests that the adverse impact on estrogen receptor negative breast cancer persists over time. The biologic mechanisms behind the association, however, are unclear. One hypothesis is that the immune system/inflammatory processes that occur after birth may play a role.

Whatever the cause, breastfeeding looks like one way to reduce risk—not to mention that it is just good for both mom and baby.

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