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