Monday, April 27, 2009

How to Counter the Side Effects of Chemo

Toward the end of my chemo treatment, my husband and I decided to celebrate my progress (any excuse for a celebration), so we went to eat at Red Lobster. Their cheese biscuits are one of my favorite parts of a meal there. This time, though, the biscuits tasted like lard. No cheese, no yummy breast taste. Just lard.

Such were the wonders of chemo that nobody told me about.


I learned a great deal on my own, so to spare you that charm,
here are some of the side effects of the chemo I had—four rounds of dose-dense Adriamycin (Doxorubicin) and Cytoxan (cyclophosphamide) every two weeks—and some suggestions for how to deal with those effects. AC, as this regimen is called, is fairly common for hormone-negative cancers, including triple-negative,  that have not spread to the lymph nodes.

Chemo, in general, kills fast-growing cells, which are often cancer cells. That’s the good side of those toxins being pumped into you. However, your body has other fast-growing cells that are also affected—in your hair, the lining of your mouth, and digestive tract. Killing these changes your body. And I was not prepared for most of that.

I went through chemo fine, for the most part, given that I was going through chemo. I kept active, ate healthy, and spent marvelous time with my friends and family. But, as with all other aspects of this lovely journey, I could have been better informed.
Losing your hair. This chemo effect is the most understood and expected. My doctor told me it would happen in the third week of chemo and, sure enough, that’s when my hair literally began coming out in chunks. Some women prepare for this ahead of time by getting their head shaved before the hair falls out. I wanted to be normal and natural for as long as I could. So, one warm June day, my hair came out like dead grass in an abandoned lot, and I literally pulled the rest out. Yes,  I pulled my hair out, and I will never be able to use that metaphor again. My husband shaved the rest.

Losing your hair is so emblematic of having cancer that the more you can address this head-on (no pun honestly intended), the better. Some women paint their heads; others have friends who also shave theirs in a gesture of solidarity. I just got a couple of pretty cool wigs and simply smiled when people complimented me on my new ‘do.

Whatever makes sense for you.

A friend did tell me that, because I am tall, I would look elegant in long scarves and could make a great fashion statement. I wanted to tell her to make her own damn fashion statement, but I know she was honesty trying to be supportive, so I said nothing. (I found, though, that I could not keep scarves on; they just kept sliding off my stupid bald head.)
Changes in your mouth. I did not expect this in the least. Because the cells on the lining of my mouth were killed, I lost a good deal of my sense of taste, which is why those biscuits tasted like lard. My acupuncturist suggested buying some Japanese plum sauce, which has a tangy taste and sort of shook up what taste buds remained. (She also told me the other day that my tongue had looked like raw meat at the time. It did feel especially raw.) I also found that chocolate malts tasted quite good.

The bigger mouth problem, though, was mouth sores. Lots of them. Doctors call this oral mucositis and recommend
a variety of things to help it, including “miracle” or “oncology” mouthwashes and antibiotics. I found an over-the-counter version that had hydrogen peroxide. Other than making me foam at the mouth like Cujo, it worked fine. I suspect that a good salt-water rinse would work as well.Digestive tract pokiness. One result of the loss of some of the cells in your digestive tract is that your digestion slows down. This is for sure the nastiest side effect of chemo, and no doctor has ever talked to me about it, but chemo patients talk about it all the time. Serious constipation. Serious. I took a natural laxative, Senna Plus, which worked OK. I often had to overdose, plus I also resorted to plain old-fashioned charmers like Milk of Magnesia.  The Mayo Clinic offers some good information on laxatives here.

I started taking a green drink every morning, a healthy tonic I still take. Green drinks are generally high in fiber and rich in antioxidants and vitamins. So they’re good for getting your digestion going and fighting the cancer. Oprah’s medical guru, Dr. Oz (really, Oz?) has a recipe online for his green drink
here.

I actually do two green drinks. In the morning, I have a powdered version that has spirulina, sea grass, organic greens, plus vitamins and minerals, like
Barlean’s Green.  In the evening, my husband makes me a fresh juice of carrots, kale, cabbage, and parsley, with apples and lemon for taste. Full of antioxidants and heavy on cancer-fighting cruciferous veggies.

The green drinks together, I think, helped move my digestion along.

I also found that I needed to increase the amount of magnesium I took, which is often a cause of constipation in folks without chemo, especially if they are taking calcium.


And exercise is essential.  I walked two miles most days, and that helped.  The more I walked, the better.Digestion tract speediness. Nausea is another effect we expect, although one oncologist told me that anti-nausea drugs added to the chemo cocktail have eliminated this problem. As if. My husband and I believed this, and we went out for lunch after my first chemo—at the suggestion of a helpful nurse I could strangle. Like a couple of certifiable idiots, we went to a great Italian restaurant where I ate spaghetti with meat sauce. I was sick for hours until I threw up the entire meal. I did not want meat sauce for years after, nor did I want to even walk into that restaurant, as though it were at fault.

I learned to eat small meals on chemo days, usually bland things like soups and toast or crackers.  I had plenty of liquids, and I went to the acupuncturist beforehand. I usually had mild nausea for about 24 hours after chemo, but nothing serious.

My sense of smell, which has always been acute, remained lively, so the smell of even bland things like mashed potatoes often turned me off. We resorted to eating as many fresh foods as we could, which is also a highly healthy way to go.

Three years later, I still think about those lardy biscuits. My taste buds got back into shape within a month or two of chemo. Now, the biscuits taste as they should—creamy, crunchy, and cheesy. I know, though, that behind all those goodies, there is lard. And that is one lesson of chemo I am choosing to ignore.

I will do the green drinks, I will eat healthy most of the time, and I will keep my weight down. Occasionally, though, I want a cheese biscuit or six, lard and all.


For more information, check out my book, Surviving Triple-Negative Breast Cancer.  You can get a free signed copy just by donating $25 to this site.  Click the Donate button on the right to donate through PayPal.   You'll then get an email from me asking how you want your book signed and where you want it sent.  Or you can buy the book directly without a donation.  Thanks!  And hugs.  

Tuesday, April 21, 2009

Zometa: Not Proven for Hormone-Negative

Zometa (zoledronic acid) has been touted as a life-saving drug, based on research in the February New England Journal of Medicine.    And it looks like the drug has serious potential—for women with hormone-positive disease.  Some things for women with hormone-negative breast cancer, including triple negative, to consider:

• The women studied were all premenopausal who were hormone-positive and were given hormonal therapy—either tamoxifen or Arimidex—plus goserelin (Zoladex) to suppress ovarian function.

• None received adjuvant (after surgery) chemotherapy;

• The study found a 98 percent chance of survival in young women who were given ovarian suppression and hormone therapy drugs but did receive any chemotherapy.

So this could be great news for a narrow group of women.  Unfortunately, this does not include those of us with hormone-negative disease.

The Dr. Susan Love Research Foundation has a great analysis of this. 

Back to the drawing board, docs.  Find us a cure.

(My thanks to the talented Deb Lattimore for sending me Dr. Love’s link.  You can read about Deb’s fight against triple negative, and enjoy her excellent photography, here. )

 

Hidden Sources of Caffeine

Caffeine has been linked to hormone-negative breast cancer, including triple negative. And it can lurk unseen in your diet.

I have been having heart palpitations, so I immediately decided that either 1) the chemo had caused heart failure or 2) I have lung cancer, putting pressure on my heart. After an X-ray showed both lungs and heart normal, I decided to get a clue and start looking at my diet to see what I was doing to cause the palpitations. If I could not find an answer, I would go to the doctor, but I suspected I could take care of this by finding culprits in my diet.

I did.

I discovered caffeine all over the place, which is bad news, because I have been avoiding caffeine, as I noted in an earlier post. Caffeine has been linked to increased risk of hormone-negative breast cancer, including triple negative.

What I learned from honestly assessing my diet:

• I had been adding green tea to my morning smoothie, thinking I was adding a jolt of health. I was, but it also came with a jolt of caffeine. I often link green tea to herbal teas and assume it is caffeine-free. In fact, it has less caffeine than black tea and much less than coffee, but it still has caffeine. Thumpety.

• I had been making some nice, strong decaf coffee daily in my French press. That’s OK, right? Wrong. Decaf has less caffeine, but it is not caffeine free. Researchers at the University of Florida compared caffeine in decaf coffee and found that different brands had from 8.6 mg to 13.9 mg, compared to an average of 85 mg for caffeinated coffee. So, the super-strong stuff I was making—and I was making a good 16 ounces of it—no doubt had the caffeine of one or two cups of regular. Add that to the green tea caffeine and I was getting quite a start to my day. Thumpety thump.

• My beloved Diet Coke still hooks me, and when I fall off the wagon, I do a great job. Restaurants give you free refills, right? Sometimes I embarrass myself with the number of times my glass is refilled. There’s about 47 mg, of caffeine in an 12-ounce serving of Diet Coke. Heaven only knows how many I have at a simple lunch. Thumpety thump thump.

• Dark chocolate is considered by some a cancer fighter because of its high levels of antioxidants and phytochemicals. And it has plenty of caffeine: 31 mg in a 1.45 oz, bar. I used to have a tiny square as a treat after a meal. That gradually expanded to 3,4,5 squares. Thumpety thump thump thump.

So, I reminded myself that I am not a bonehead, that I am supposed to be eating healthy, and that I am supposed to know these things. I cut the hidden caffeine from my diet for three days and, guess, what? No palpitations.

I am frankly a bit embarrassed about this, but I am fairly sure I am not the only person who gets caught in the unhealthy caffeine trap. My heart told me to stop. That is way better than a cancer recurrence.

And searching my own diet was far cheaper, easier, and more successful than going in for heart tests.


Friday, April 10, 2009

Laughing at Triple Negative Breast Cancer

Here's a great story from the Tulsa World:

Trudy Runnels is a 44-year-old mother from Waxahachie, Texas. She has a rare form of metastatic breast cancer (triple- negative). It is not funny. Trudy is.

On a recent afternoon, at Cancer Treatment Centers of America, Runnels and a handful of other cancer patients gathered in a group therapy session. Together, their laughter became medicine.
After all, a funny story can do the most amazing things for a cancer patient, according to Dr. Gerald Ellison, a psychologist who leads the Centers' weekly humor therapy class.

"Laughter stimulates the immune system to produce cells that are very powerful in fighting cancer," Ellison explained. " There are many medical benefits to laughter." Read more
here.

University of Alabama to Search for Triple Negative Therapy

One of the reasons triple negative breast cancer is so lethal is because it does not respond to standard follow-up treatment, like tamoxifen or Arimedex, which is a highly successful therapy for hormone-negative cancer, although chemotherapy has been found to be effective for all hormone negative cancers.

Now, Komen for the Cure and the Triple Negative Breast Cancer Foundation have awarded $6.4 million to the University of Alabama at Birmingham to study the development of a drug to be used with chemotherapy to treating triple negative breast cancer.

Researchers will also study ways to predict the therapies that will be most effective against triple negative breast cancer.

More good news--evidence that this cancer has caught researchers' eye. Yea.

Saturday, March 21, 2009

Choosing the Best Doc for You.

Doctors are a mixed bag and some are better than others.  That's just natural.  As the old joke goes:  What do you call the person who graduated last in his medical school class?  Doctor.

But you want the best person for you because cancer is a big deal and getting the right treatment is literally a case of life and death.  How to find the right healthcare team to walk this walk with you?  Here are some tips.

1. Trust your gut. If you don’t like the doc, he just might feel the same way, and that could affect your treatment.
2. Get the best care you can afford. If this means heading out of town, do it. Cancer is a big deal; it deserves the best docs. US News and World Report lists the top 50 cancer centers
here.
3. Do your research. On the left, I have listed some top websites for breast cancer information. Spend some time with these excellent resources--you'll learn a great deal.

4. Ask questions. A good doctor will take time to answer them. My radiation oncologist even drew a picture for me, explaining how radiation works. More evidence that she was good. She spent more than an hour talking about all types of treatment with me and my husband. And she treated me like a smart adult who could understand her.
5. Write down the answers. I still consult my treatment notebook, in which I wrote what the doctor said—direct quotes in quote marks, journalist that I am. This comes in handy for follow-up research.
6. Call back with questions. This is your life. If things aren’t making sense the way they should, ask.
7. Respect even the worst doctors. First, respect breeds respect. Second, these folks spend their lives around cancer, so they deserve a break. That said, if they are not serving you well, go elsewhere.
8. Find a patient advocate. If you cannot wrap your head around this information, don’t try to go it alone. Better yet, go to a center that has a Nurse Navigator program—these people are trained to help you make sense of treatment. They ask the questions you don’t know to ask, and they understand the answers.
9. Get copies of all your reports, especially your pathology reports. This is how I found out what doctors said about me.

Tuesday, March 10, 2009

Oprah's Article on Triple Negative

O, the Oprah Magazine, ran an article on triple negative breast cancer a while back:

The Breast Cancer Nobody Is Talking About
By Mary A. Fischer
One virulent, fast-acting type of breast cancer attacks 
more than twice as many young black women as all other women.

In May 2006, as she was getting dressed for work, Lori Booker felt a small lump in her left breast. Only 32, she was concerned but thought it was probably just a cyst and made an appointment to see her gynecologist. With a demanding job as a computer teacher at a Chicago public high school, Lori missed a couple of appointments, and two months later, when she finally had her first mammogram, the lump had doubled in size. A biopsy came back with grim results: She had aggressive, advanced-stage breast cancer. Crying, Lori thought the lab must have made a mistake. "I'm too young for this," she sobbed. more.

Sunday, March 8, 2009

TAC Improves Disease-Free Survival for Triple-Negative Breast Cancer

What type of chemo works best for triple negative breast cancer? If it’s early stage but has progressed to the lymph nodes, docetaxel, doxorubicin, and cyclophosphamide (TAC) was the most effective according to research published in the March 2009  Journal of Clinical Oncology.

TAC also worked well for those with luminal B who also took tamoxifen.

(Most patients know doxorubicin as Adriamycin and cyclophosphamide as Cytoxin.)

Researchers assessed different types of breast cancer to determine their value in evaluating patients’ prognoses and their responses to adjuvant chemotherapy (chemo after surgery). The types they studied:

• triple negative (estrogen receptor [ER]–negative, progesterone receptor [PR]–negative, HER2/neu [HER2]–negative).

• HER2 (HER2-positive, ER-negative, PR-negative);

• luminal B (ER-positive and/or PR-positive and either HER2-positive and/or Ki67high);

• luminal A (ER-positive and/or PR-positive and not HER2-positive or Ki67high);
 
They studied 1,350 patients from the Breast Cancer International Research Group (BCIRG) 001 trial. Of these:

•14.5 percent were triple negative, with a three-year disease-free survival (DFS) of 67 percent;

• 8.5 percent were HER2, with a three-year DFS of 68 percent;

• 61.1 percent were luminal B, with a three-year DFS of 82 percent;

• 15.9 percent were luminal A, with a three-year DFS of 91 percent.

Source:
Judith Hugh, John Hanson, Maggie Chon U. Cheang, Torsten O. Nielsen, Charles M. Perou, Charles Dumontet, John Reed, Maryla Krajewska, Isabelle Treilleux, Matthieu Rupin, Emmanuelle Magherini, John Mackey, Miguel Martin, Charles Vogel, “Breast Cancer Subtypes and Response to Docetaxel in Node-Positive Breast Cancer: Use of an Immunohistochemical Definition in the BCIRG 001 Trial,” Journal of Clinical Oncology, 27 (8 ), 1168-1176. 2009.

Friday, March 6, 2009

Consider Signing Up for a Breast Cancer Clinical Trial: Here's How

Breastcancer.org, one of my favorite sites, has important information on clinical trials for breast cancer:

Clinical trials are research studies in which people agree to try new therapies (under careful supervision) in order to help doctors identify the best treatments with the fewest side effects. These studies help improve the overall standard of care.

Today, fewer than 5% of breast cancer patients receive treatment for their disease in a clinical trial. Why? One factor is that information about current trials and how to enroll in a trial are often not well understood. In this section, you can learn more about what clinical trials involve and how to join one.
more. 

Wednesday, March 4, 2009

Cases of Hormone-Negative Cancers Decreasing

Good news for our daughters and granddaughters:

Women are increasingly more likely to have the less aggressive form of breast cancer, hormone-receptor-positive (ER-positive and PR-positive), with smaller tumors, according to research published in the March 2009 British Journal of Cancer.

Scottish researchers compared 420 tissue samples from 1984 and 1986 with 653 from 1996 and 1997. In that ten-year span, they found that the proportion of estrogen-positive cancers rose from 64.2 percent to 71.5 percent. More grade one tumors were also diagnosed.

The good news here is that these cancers are easily treatable, offering a more positive prognosis than estrogen-negative cancers.

Why?

Lifestyle changes could be one influence, as could better screening.  As usual, doctors say more research is necessary.   

Source: 
Brown, SBF, Mallon, EA, Edwards, J, Campbell, FM, McGlynn, LM, Elsberger,B, and Cooke,TG, “Is the biology of breast cancer changing? A study of hormone receptor status 1984–1986 and 1996–1997, British Journal of Cancer (2009) 100, 807–810. doi:10.1038/sj.bjc.6604934 www.bjcancer.com





Urine test can show spread of estrogen-receptor-negative breast cancer

Breast cancer spread—especially of estrogen-receptor-negative, including triple negative—can be detected through a urine test. 

This is according to research published online in Proceedings of the National Academy of Sciences February 23.   The urine test can detect tumors that are about to metastasize because they go through a process also seen in the development of human embryos, called epithelial to mesenchymal transition (EMT).  Phew!   A protein called lopcalin 2 (lcn2)  triggers the EMT in breast cancer and can be detected in urine. So a simple urine test for lcn2 could potentially predict the spread of cancer.  Women whose cancer has spread have especially high levels of lcn2.

“Lcn2 is among the genes most highly associated with estrogen receptor-negative breast tumors,” researchers Marsha Moses, Jiang Yang and colleagues at Children’s wrote.

Lipocalin 2 has been licensed to Predictive Biosciences,  in Lexington, Massachusetts for development of clinical use, which means the test may eventually be available for consumer use, although the process from laboratory tests to doctors' use can be slow and cumbersome.

Source:  

Jiang Yang, Diane R. Bielenberg, Scott J. Rodig, Robert Doiron, Matthew C. Clifton, Andrew L. Kung, Roland K. Strong, David Zurakowski, and Marsha A. Moses. Lipocalin 2 promotes breast cancer progression. Proceedings of the National Academy of Sciences, 2009; DOI: 10.1073/pnas.0810617106

Tuesday, February 17, 2009

Surviving Triple Negative Breast Cancer

If you’ve been diagnosed with hormone negative breast cancer, your doctor may have frightened you with the terms aggressive or lethal. Yes, this cancer is more on the march than estrogen positive, but it is survivable—and most women do survive it.  That fact too often gets lost in research reports.

Some stats.

63 percent of women with triple-negative status survive progression-free for three years, compared to 76 percent of hormone-positive women. That’s a lower number, but it still means most women survive. This comes from research in the International Journal of Cancer.

Women with hormone negative had a lower risk of recurrence at five years than hormone positive, according to research at the University of Texas M.D. Anderson Cancer Center. Five years after beginning therapy—chemotherapy, radiation, tamoxifen or all three—those with hormone negative disease faced a seven percent chance of recurrence, while those with hormone positive had a 13 percent chance. Or looking at it another way, 93 percent of those with hormone negative survived after five years while 87 percent of those with hormone positive did.

Docs say that, because more hormone-negative cases relapse within the first three years, women with this disease who are disease-free at five years have especially good odds. And at five years post-diagnosis, they have a better prognosis than women with the less lethal form of cancer.


Please support this site with your donations—that's what keeps it going.  Plus, if you donate just $25 you'll receive a copy of my book, Surviving Triple-Negative Breast Cancer. Click the Donate button on the right to donate through PayPal.   You'll then get an email from me asking if you want the book, how you want it signed and where you want it sent.  And if you just want to donate without receiving the book, that's wonderful. Thanks!  And hugs.   




Source: Bertucci F, Finetti P, Cervera N, et al: “How basal are triple-negative breast cancers?” International Journal of Cancer. 123:236-240, 2008.

Source: Brewster AM, Hortobagyi GN, Broglio KR, Kau SW, Santa-Maria CA, Arun B, Buzdar AU, Booser DJ, Valero V, Bondy M, Esteva FJ. “Residual risk of breast cancer recurrence 5 years after adjuvant therapy,” Journal of the National Cancer Institute, 100(16):1179-83. 2008.

Monday, February 16, 2009

Triple Negative Breast Cancer: Research Review 2

More take-outs from researchers Carey Anders, M.D., and Lisa A. Carey, M.D., in their research review of triple negative in the journal Oncology October 1, 2008. The entire article is available online.

Most, but not all, triple-negative breast cancers are basal-like.

Triple-negative breast tumors have been correlated with onset at a younger age, higher mean tumor size, higher-grade tumors, and, in some cases, a higher rate of node positivity.
 
Basal-like breast tumors were more likely among women who were younger at the onset of menstruation; have borne several children; were at a younger age at full-term pregnancy; had a shorter duration of breast-feeding; and higher body mass index (BMI) and waist-to-hip ratio (WHR), especially among premenopausal patients.

Women with triple-negative breast cancer were much more likely to develop a recurrence during the first 3 years following therapy with rapid declines thereafter. Translation: We can relax a bit after three years.

Patients with a “pathologic complete response”—meaning all traces of the cancer were eliminated— had excellent outcomes regardless of whether they were hormone positive or negative.

Source: C. Anders and L. A. Carey, “Understanding and Treating Triple-Negative Breast Cancer,” Oncology, Vol. 22, No. 11, October 1, 2008.

Nutrition Affects Hormone Negative Disease: An Overview

In her blog, Breast Cancer Information, Kim Dalzell, a doctor of holistic nutrition and registered dietitian,  offers insight into fighting hormone ngative breast cancer. Some of the points she makes:

Women who scored high on Harvard University's Alternate Healthy Eating Index had a lower risk of estrogen receptor negative breast cancer. The guidelines for this index: a daily intake of 9 servings of fruits and veggies, 7 or more grams of dietary fiber, 30-40 percent less saturated fat than polyunsaturated fats, less than 3 grams of trans fats and consuming 1 ounce of nuts. (February 2006, Journal of Nutrition.)

Women whose diets were deficient in folate, a B vitamin, had an increased estrogen receptor negative breast cancer risk. Folate-rich foods include: fruits like cherries, oranges and strawberries, beans and peas, and dark, green leafy veggies. (August 2005, Cancer Epidemiology Biomarkers and Prevention.)

Alcohol robs the body of folate and other B vitamins, so it's prudent to enjoy alcohol only occasionally, if at all. (August 2005, Cancer Epidemiology Biomarkers and Prevention.)

High intakes of linoleic acid were associated with more than a 300 percent greater risk of estrogen receptor negative disease than estrogen receptor positive disease. Linoleic acids are found in polyunsaturated fats like cottonseed, soybean, and corn oil as well as vegetable-based margarines. (The University of Texas MD Anderson Cancer Center research.)

Among premenopausal women, there was a reduced risk of both estrogen receptor negative and estrogen positive breast cancer for those women who consumed the highest lignan intake. Lignans are found in flaxseed, and to a lesser degree in sesame seeds and kale. (Breast Cancer Research Treatment journal, October 2006.)

Wednesday, February 11, 2009

New Breast Cancer Classifications

The American Cancer Society explains new classifications of breast cancer based on genetic research on its Web site. 

I quote them directly below.

The current types of breast cancer are based largely on how tumors look under a microscope. A newer classification, based on molecular features, may be better able to predict prognosis and response to several types of breast cancer treatment. The new research suggests there are 4 basic types of breast cancers:

Luminal A and luminal B types: The luminal types are estrogen receptor (ER)-positive, usually low grade, and tend to grow fairly slowly. The gene expression patterns of these cancers are similar to normal cells that line the breast ducts and glands (the lining of a duct or gland is called its lumen). Luminal A cancers have the best prognosis. Luminal B cancers generally grow somewhat faster than the luminal A cancers and their prognosis is not quite as good.

HER2 type: These cancers have extra copies of the HER2 gene and several other genes. They usually have a high-grade appearance under the microscope. These cancers tend to grow more quickly and have a worse prognosis, although they often can be treated successfully with targeted therapies such as trastuzumab (Herceptin) and lapatinib (Tykerb).

Basal type: Most of these cancers are of the so-called "triple negative" type -- that is, they lack estrogen or progesterone receptors and have normal amounts of HER2. The gene expression patterns of these cancers are similar to cells in the deeper basal layers of breast ducts and glands. This type is more common among women with BRCA1 gene mutations. For reasons that are not well understood, this cancer is also more common among younger and African-American women.

These are high-grade cancers that tend to grow quickly and have a poor prognosis. Hormone therapy and anti-HER2 therapies like trastuzumab and lapatinib are not effective against these cancers, although chemotherapy can be helpful. A great deal of research is being done to find better ways to treat these cancers.

It is hoped that these new breast cancer classifications might someday allow doctors to better tailor breast cancer treatments, but more research is needed in this area before this is possible.



Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.


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New Test Helps Predict Outcomes for Hormone-Negative

A new test can predict the most effective therapy for all women with breast cancer, including those with hormone-receptor-negative—estrogen-negative, progesterone-negative, Her2- negative, or a combination of all three, according to research conducted at Washington University School of Medicine in St. Louis and reported in advance of publication in the Journal of Clinical Oncology. Using a set of 50 genes, the test goes beyond the existing Oncotype DX test to offer diagnostic help that covers the four known types of breast cancer— luminal A, luminal B, HER2-enriched and basal-like. The last three types are generally considered types with a poor prognosis.  

Hormone-negative cancers, especially triple-negative, are most often basal-like.  Luminal A and B are hormone-positive; luminal B grows faster than luminal A.

"Unlike a widely used genomic test [Oncotype DX] that applies only to lymph-node negative, estrogen-receptor positive breast cancer, this new genomic test is broadly applicable for all women diagnosed with breast cancer," says breast cancer specialist Matthew Ellis, M.D., Ph.D., a member of the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University.

In comparing the activity of the 50 genes to how well 133 breast cancer patients responded to chemotherapy, researchers found that the genetic test was highly sensitive and could predict chemotherapy response better than estrogen receptor status, progesterone receptor status or HER2 gene expression status.

Luminal A , a cancer that typically comes with a good prognosis, was not sensitive to chemotherapy, meaning that patients with that type can avoid chemotherapy in favor of hormone-based therapy. Among the poor-prognosis tumor types, basal-like breast cancer was the most sensitive to the chemotherapy and luminal B the least sensitive.

"Luminal B tumors are a very poor prognosis group, and none of the current conventional therapies are particularly effective against it," Ellis says. "The ability to identify luminal B tumors accurately makes it possible to develop better therapies for this type."

The researchers are investigating how each tumor type responds to the more than 50 drugs used for breast cancer. Because the gene set can be used with preserved tumor samples, the researchers plan to study tumor samples from breast cancer cases going back a decade or more. Patients in these cases have already been treated, which means the researchers can assess how well therapies worked for various breast cancer types.

NOTE:  The test is not yet available for consumer use.  I will research this and post additional information on when and where we might be able to have the test.

Friday, February 6, 2009

Hispanic Women Face Multiple Threat of Breast Cancer

Breast cancer in Mexican and Mexican-American women is likely to be
 
• detected at a later stage, leading to higher grade tumors; 
• triple-negative breast cancer, which is more aggressive. 

Mexican and Mexican-American women are also likely to have a family history of breast cancer, suggesting the BRCA gene mutation. 

This comes from preliminary results of a study led by Elena Martinez, Ph.D., of the University of Arizona and Arizona Cancer Center in Tucson and presented at the American Association for Cancer Research Science of Cancer Health Disparities Conference in Arizona. 

Of the 652 women in the study—309 living in the United States and 343 in Mexico—

• Only 22 percent reported that their cancers were found by mammography; the rest were found by palpable lumps, which often means a more advanced form of cancer.
• 28.1% of Mexican women and 19.3% among Mexican-Americans were diagnosed with triple-negative—Estrogen-negative, progesterone-negative and Her2-negative.
• most were overweight, with  high body-mass-indexes.

The limitation of this information:  

• the study has yet to be published—information was presented as an abstract only;
• the sample size was small;
• the sample did not include women without breast cancer for comparison.



Wednesday, January 28, 2009

Aspirin Doesn’t Reduce Breast Cancer Risk

A daily aspirin might aid the heart, but it offers little help in reducing the risk of breast cancer in premenopausal women, according to research data from the Nurses’ Health Study, published in the Archives of Internal Medicine. Use of other non-steroid anti-inflammatory drugs, or NSAIDs, also had no effect.

This is true regardless of dose, duration of use, and hormone-receptor status.

Earlier studies in mice had shown a preventive effect on breast cancer, but that so far has no translated to humans.

Surgery for Women with BRCA Gene Can Prevent Cancer

Removal of ovaries and fallopian tubes reduces cancer risk for women with BRCA1 and BRCA2 gene

Surgery to remove the ovaries and fallopian tubes has long been considered one of the most effective ways to decrease the risk of breast and gynecologic cancer for women with the BRCA1 or BRCA2 gene mutation. Now, research in the Journal of the National Cancer Institute underscores the effectiveness of the surgery. According to the research, an analysis of 10 independent studies, the risk reduction of this surgery—salpingo-oophorectomy—can be 80 percent for ovarian or fallopian tube cancer and 50 percent for breast cancer.

The BRCA genes are associated with triple-negative breast cancer, one of the most dangerous forms. Women with triple negative estrogen-negative, progesterone-negative, and Her2-negative.

Nevertheless, the researchers note that the  surgery is not the only route to risk reduction. Mastectomy and regularly MRI screenings have also been effective.

Source: “Meta-analysis of Risk Reduction Estimates Associated With Risk-Reducing Salpingo-oophorectomy in BRCA1 or BRCA2 Mutation Carriers,” Timothy R. Rebbeck, Noah D. Kauff, Susan M. Domchek, Journal of the National Cancer Institute, 101 (2), 2009, 80-87

Friday, January 23, 2009

Breast Cancer and the Economy

The economy is affecting all aspects of our lives, including cancer treatment. Breastcancer.org surveyed 500 breast cancer patients and survivors and found:

• 67% are concerned about how the economy will impact their breast cancer treatment or management.

• Among those who have finished treatment, 65% indicated that they’re concerned about how the economy might impact breast cancer management.

• 12% have had to alter their treatment plan because of a change in their financial situation or increasing costs: They have:

• Had to change s treatment plan. For example, they had to choose a shorter duration of treatment, select a less expensive treatment, or change a treatment location.

• Sought help from an assistance program, such as Medicaid or Medicare.

• Had to forgo treating another health condition in order to pay for breast cancer treatment.

• Have had to postpone treatment.

For a more analysis, insight, and suggestions for help, read breastcancer.org’s Breast Cancer Treatment and the Economy