TNBC Tied To Type 2 Diabetes in African-American Women

African-American women with type 2 diabetes had a higher risk of developing estrogen receptor (ER)-negative breast cancer, which includes TNBC, in research published in Cancer Research, a journal of the American Association for Cancer Research.  

Here’s what’s really interesting: The association was observed only among women with BMIs under 30, which could mean that abnormal metabolic status may play a larger role in ER-negative breast cancer than obesity.

The results showed an increased risk of ER-negative breast cancer primarily in black women who had type 2 diabetes for at least five years. Researchers found no association with ER-positive breast cancer in the same group.

African-American women who get breast cancer are more likely to get TNBC than white women, with double the incidence as compared to white women, according to the paper’s author, Julie R. Palmer, ScD, associate director of Boston University’s Slone Epidemiology Center. And type 2 diabetes is also twice as prevalent in African-American women.

“We are still trying to understand the basic biological processes that lead to ER-negative breast cancer. One way to do this is to study factors that are more common in an African-American population,” she said. Several studies suggest that diabetes is a risk factor for breast cancer and insulin resistance is a factor in TNBC.

The study was based on information provided by participants in the Black Women’s Health Study (BWHS, which uses twice-yearly questionnaires from 59,000 African- American women from across the United States.

 “Our findings may account for some of the racial disparity in breast cancer, and could partly explain why mortality from breast cancer is so much higher in black women than white women,” Palmer said. “Women could reduce their chances of getting ER-negative breast cancer if they could avoid developing type 2 diabetes. Monitoring of blood sugar levels to identify pre-diabetes may allow for early interventions to prevent diabetes.”

For more information on TNBC, check out my book, Surviving Triple-Negative Breast Cancer.  And your support of this site is important. Even a small donation keeps me going. Check the "donate" button at the top right of the page. Thanks much.

Ten Years After Breast Cancer And Competing In Ironman Triathlon

This coming February will be Julie Desloge’s 10^th cancerversary—she had triple-negative—and she’s leading up to the celebration by training for her first full Ironman race. (Shouldn't that be Ironwoman?)  She will swim 2.4 miles, bike 112 miles and run 26.2 miles, all in less than 17 hours.

Julie biking in the Hagg Lake Triathlon in Oregon in July.

            Chew on that a minute. She will be running a marathon plus biking more than a hundred miles and swimming the equivalent of 85 laps in an average swimming pool. If you drove 112 miles in your car at 70 miles per hour, it would take you an hour and 36 minutes. But Julie’s doing it on her bike, plus that marathon and swimming thing. In 17 hours.

            Phew, Julie. Way to kick cancer out of your life.

            We're all doing what we can to recover and maintain our health, but it's nice to have Julie out there overachieving for all of us.

            She also doing it to raise money for The Breast Cancer Research Foundation.  which gets top ratings from Charity Navigator. 

            You can follow Julie’s blog as she prepares for the race, which is scheduled for April 2018. Julie has been racing since 2010, just two years after her diagnosis. Here’s some of what I wrote about her in my book:

Here’s one way to get over the worries about cancer treatment and the fears of its return: run a triathlon or two. That’s the approach Julie Desloge took—she completed her first sprint triathlon in June 2010, a little more than two years after she was diagnosed with triple-negative.  She participated in two additional races that summer—and her radiation oncologist was her teammate on the third.            On that race, her doctor swam 1.5 kilometers, her husband ran 10 kilometers, and Julie biked 40 kilometers. That translates to slightly less than a mile swim, a 24.8-mile bike ride, and a 6.2-mile run.
            Julie was diagnosed with a 2.6-centimeter tumor in February 2008 when she was 41. She had neoadjuvant chemotherapy—four rounds of Taxotere and Cytoxan—that got rid of all but .3 centimeters of the tumor, a nearly 90 percent reduction.            Easily speaking the jargon on cancer, she says, “No pathologically complete response for me.”  And, while her response was only partial, it nevertheless was significant, offering her a positive prognosis.
            A lumpectomy followed chemo, with radiation after that.
            Risk factors?  She’s negative for the BRCA mutation, but wonders about her reproductive history—she started her periods young, at age 11.  And she’s the mother of three children, who were 11, 9, and 6 at the time of diagnosis, although she breastfed all three for nine to ten months.
            She was about 15 pounds overweight when she was diagnosed; Taxol added another 8 pounds or so.  Her weight continues to be a challenge, even with her high level of exercise.  She now weighs more than she did at diagnosis, although much of that is probably muscle, which weighs more than fat.  “I haven't really found the key to unlocking much weight loss,” she says.  Still, we’re talking about being only slightly beyond her ideal—Julie says her BMI is a healthy 24.8.
            She had been exercising regularly before cancer, doing cardio and resistance exercises four to five days a week. But she upped the ante after treatment and hit the triathlon circuit near her Portland, Oregon home.         Cancer, she says, not only gave her motivation to maintain a healthy lifestlye, but it provided a chance to look outside herself at what others are going through. She’s bothered when friends protest that they should not complain about any problems they encounter, given what she faced in cancer treatment.  “Pain is pain,” she says.

             Julie remains grateful for her continued health and her ability to compete, knowing how many other beautiful women have been denied that chance. In a recent post about gratitude, she quoted Psalm 139:14:

“I will give thanks to You, for I am fearfully and wonderfully made; Wonderful are Your works, And my soul knows it very well.” As a breast cancer survivor, I have been in awe about how fragile and strong the human body can be at the same time, affected with disease, yet able to withstand the rigors of cancer treatment. I have always been grateful for that, and grateful to be able to thrive at life now.

Julie is carrying a list of the names of breast cancer survivors in whose honor she competes and a list of the names of those in whose memory she competes. She'll carry the names with her across the finish line. If you want to add a name, let her know.

This site is entirely volunteer. Please consider supporting this work through your donation.

Premenopausal Women with Belly Fat More at Risk of TNBC

Me: Normal BMI, but with
tummy fat. I've had
TNBC twice. I'm 11 years
past the first diagnosis.
two years past
the second.

Women whose fat accumulates around their stomachs and internal organs—called visceral fat—are more at risk of estrogen negative breast cancer, including triple-negative, according to research published in the Oncologist. The increased risk comes even if they are not overweight—that is, if they have a normal body mass index (BMI). The risk increases is they are past menopause. [PAT’S NOTE: This is me.]

            By contrast, overweight women whose fat accumulates in the thighs, hips, or buttocks—called subcutaneous fat—are more at risk of estrogen positive breast cancer. In this case, having a high BMI and being premenopausal increases the risk.

            “A possible reason is that subcutaneous fat is involved in estrogen production, which may promote ER+ breast cancer,” says corresponding author Zhigang Yu at the Second Hospital of Shandong University in China. “Visceral fat is more closely related to insulin resistance and may be more likely to promote ER- breast cancer.”

            For the study, researchers recruited 1,316 Han Chinese women between 25 and 70 in Northern and Eastern China who were newly diagnosed with breast cancer and compared their body types to women who had not had breast cancer.

            Asian women tend to be slimmer than their American counterparts, but those who are overweight typically carry visceral fat. Subcutaneous fat is more common in the United States. Could that be why ER+ cancer is more common here?

To sum up: 

• Women with belly fat who are past menopause are at increased risk of TNBC, even if they are not overweight.

• Women who over overweight, with fat in thighs, hips, and buttocks and who are premenopausal are at risk of ER+ breast cancer.

Studies Show Obamacare Improves Breast Cancer Prognosis, Cutting Medicaid Puts Women at Risk

Two separate analyses demonstrate that women with access to mammograms 
and other breast cancer screenings are diagnosed at earlier, more treatable, 
and less costly stages.

More women were diagnosed with early stage breast cancer after the Affordable Care Act took effect, according to a study published this month in the journal Cancer Epidemiology.  Equally important, there was a decrease in later stage, and more serious, cancers.

Late-stage breast cancer is more costly to treat and is more likely to be fatal than early-stage cancer.

Increases in early diagnoses were higher among African American and Latina breast cancer patients. 
In the past, the cost of mammograms has prevented many Latinas and African Americans to receive mammograms overall or at recommended intervals.

The Affordable Care Act eliminated copayments and other out-of-pocket costs for 45 preventive care services, including mammograms, making them more affordable and leading to the potential for earlier diagnoses, researchers say. Diagnosing breast cancer when it is still in Stage 1 could improve the prognosis for thousands of women and reduce the need for expensive and invasive treatments such as chemotherapy, wrote lead author Abigail Silva, PhD, MPH, of Loyola University Chicago Stritch School of Medicine.
 

The study included 470,465 breast cancer patients between the ages of 50 and 74 who were covered by private insurance or Medicare and were newly diagnosed with breast cancer. Researchers examined two time periods: 2007-2009 (before the Affordable Care Act took effect) and 2011-2013 (after the act took effect). They used data from the National Cancer Database, which includes approximately 70 percent of all newly diagnosed cancers in the United States from about 1,500 hospitals.
 

Overall, the number of breast cancers that were diagnosed at Stage 1 increased 3.6 percent, from 54.4 to 58.0 percent. There was a corresponding decrease in Stage 2 and Stage 3 diagnoses, while the proportion of Stage 4 cancers did not change.

The diagnosis of Stage 1 breast cancer increased by 3.2 percentage points among whites, 4.0 percentage points among African Americans and 4.1 percentage points among Latinas. 


Historically, more white women are diagnosed with Stage 1 breast cancer, while African Americans and Latinas are diagnosed at a higher stage. This disparity decreased following the Affordable Care Act, as minorities saw improvements in Stage 1 diagnoses.
 

This is especially significant for triple-negative breast cancer, which has been shown to be more prevalent and aggressive among African Americans.

Cutting Medicaid Puts Women At Risk

Tennessee women with breast cancer were more likely to be diagnosed at later, more dangerous, stages after a substantial rollback of Medicaid coverage for adults in the state, with the biggest effects being among women in low-income areas, according to an analysis published in the journal Cancer.

Researchers analyzed Tennessee Cancer Registry data from 2002 to 2008 and compared women 
diagnosed with breast cancer who lived in low-income zip codes with a similar group of women who 
lived in high-income zip codes, before and after Tennessee’s Medicaid restrictions. They found that 
women were not only diagnosed at later stages but also experienced more delays in treatment after 
the restrictions were imposed. Low-income women had a 3.3 percent increase in late-stage diagnosis 
compared to those with higher incomes.

Tennessee restricted Medicaid enrollment in 2005

The findings suggest that women did not get screenings or other essential primary care that may 
have led to an earlier diagnosis, according to team leader Wafa Tarazi, PhD, of Virginia 
Commonwealth University. The reason: lack of affordable care.

“Medicaid rollbacks may contribute to widening disparities in health outcomes between low-income women and their wealthier counterparts,” said team leaders Lindsay Sabik, PhD, of the University of Pittsburgh, another team leader.