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.

It's easy to donate to this blog—just click the "Donate" button in the right hand column.  Thanks many times.

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