Peace, Love and a Cure 2011

Last week, the rain in the tri-state area stopped long enough for a few rays of sunshine to fall on New Jersey as the Triple Negative Breast Cancer Foundation celebrated its 4^th “Peace, Love and a Cure” event.  It was a beautiful evening, attended by over 300 supporters, with the highlight being our wonderful honorees: Karen Wittweger of Genentech, Dr. Lisa Carey and Jennifer Griffin.  Many of you are undoubtedly familiar with Jennifer through her work as a Mideast correspondent for Fox News.  Others may know her through her work as a tireless advocate for triple negative breast cancer, since her diagnosis almost 2 years ago.  Jennifer has brought new visibility to the TNBC cause through her many appearances, her blog and her determination to spread awareness.  We were honored to honor her with the Champion Award!

It is my pleasure to share Jennifer’s inspirational words:

When I was diagnosed with Stage 3 Triple Negative breast cancer on September 28, 2009, I was still nursing my son, Luke. He was just six months old. Our two daughters were 7 and 9 and I immediately realized that if I was going to beat my diagnosis that I was going to have to use all of the skills that I had developed over the years as a journalist covering other people’s wars. I had covered famine in Somalia, Mandela’s release from prison, nearly a decade of fighting between the Israelis and Palestinians, the Iraq and Afghan wars after 9/11. This, too, was a war. It just happened to be in my breast. Seventeen rounds of chemo, a double mastectomy, 6 and a half weeks of radiation and word from my oncologist on April 20, 2010 – my 41st birthday – that I had had a complete pathologic response to the chemotherapy and that there was no sign of cancer. My surgeons had rebuilt me and I felt like the bionic woman with my new breasts. I never would have gotten through my months of chemo and fear that I wouldn’t see my children grow up without the love and support of my friends and family and my extended family at Fox News. My mom, herself a breast cancer survivor, gave me a pep talk and told me I was going to survive. Greta Van Susteren gave me a video camera so that my girls could document the fight. My girls, Annalise and Amelia, kept me laughing and came with me to shave my head and buy my wigs, which they aptly named “the Miley” or after various American Idol stars. My husband Greg did what he does best – remained positive and diverted me by making me pen certain chapters in our book, “This Burning Land” about our years in the roiling Middle East while the doctors gave me chemo. My friends got together and hired a personal chef to start feeding me ultra healthy food because I soon learned that while Triple Negative patients don’t have a tamoxifen or herceptin, we do have a low saturated fat diet and 45 minutes of exercise a day that can lower our chance of recurrence by nearly two-thirds. My friends didn’t trust me to kick my bagel and cream cheese habit so they began food deliveries and nursed me back to health. I learned that food could be medicine and I took up Pilates, which gave me crazy core strength going into the mastectomy. My doctors at Georgetown University’s Lombardi Cancer Center saved my life. I don’t know how to thank them except to do what you all are doing tonight, raising awareness and funds to help the brilliant researchers out there find a cure for Triple Negative Breast Cancer so that no young mother or any woman for that matter will have to go through what I went through. I am the luckiest girl in the world. And with your help, we will find “Peace, Love and A Cure.”

Visit Jennifer’s blog for more on her life as a news correspondent, and about her TNBC journey.

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A Belated Mother’s Day Gift

This blog entry comes to us courtesy of one of the Triple Negative Breast Cancer Foundation’s longtime forum members, Natalia M., who shares with us her very personal story about motherhood and TNBC.  Thank you, Natalia, for your “gift” to us all!

Tough decisions (or my quest through whether or not to have a child after breast cancer treatment)

*** Disclaimer:  I hate to start my blog post with a disclaimer but this is the lawyer in me speaking. This blog post is the result of my own personal views and experiences and it doesn’t intend to give any type of medical advice or to influence anyone’s decisions with regards to the issues addressed herein.

  It was at my second opinion surgeon’s appointment that the issue of fertility and cancer treatment was brought to my attention after my cancer journey began. I had been married for over seven years and we had waited for the right moment to have children. I had a miscarriage on our first try. Thankfully we were able to get pregnant easily again and after an uneventful and very happy pregnancy I gave birth to a beautiful healthy boy.

 I had returned back to work and was juggling motherhood and work and I had never been happier. When I was diagnosed with breast cancer the news came to me like a shock; like if I had hit a wall in the middle of the road during a beautiful drive. Of course the first thing that came to my mind was my son. I didn’t want to leave a baby so young without a mother; I didn’t want to think about all the possibilities down that road. I immersed myself in research about triple negative breast cancer and what to do about it and how to improve my chances of being able to see my son grow up.

 But during those crazy, anguish-filled, uncertain and almost surreal weeks, I didn’t think about the possibility, or not, of having more children. When the doctors told us about the fertility issues related to cancer treatment we were faced with yet another important decision to make. We were given the option of seeing a fertility specialist in order to take steps such as freezing embryos or eggs in order to ensure that we could have more kids in the future. For both my husband and I our siblings are a very important part of our lives, so we definitely wanted our son to have them; and we enjoyed being parents so much that we had already talked about trying to have at least one or two more babies.

 However, when we researched about the fertility treatments we learned that I would have to receive treatment with hormones, which would put me in increased risk for cancer on its own (and it could also affect the breast cancer that I already had). So at that moment I decided to focus on getting rid of my breast cancer, as my son was my first priority and I needed to do all I could to make sure I would be there for him. We also knew that studies show that the younger a woman is when going through chemo the better her chances are of being able to conceive. We left it in God’s hands and went ahead with surgery and chemo.

 Once I was done with chemo and radiation I found myself looking forward to having my period back.  It was also the time for me to face the decision of what to do about my ovaries.  The fact that I have the BRCA 1 mutation makes me prone to both breast and ovarian cancer. When I talked about that subject with my doctors, the children issue inevitably came up. They all told me they believed I would get my period back and that it would be safe for me to eventually have children.  They all said that the body got rid of all residues from chemo and radiation quickly and at that time, about 5 months after finishing radiation, my blood counts and the rest of my body were back to normal and healthy enough for me to have a baby.  However their opinions differed as to when it would be wise for me to get pregnant again.

 Half of my doctors said that I should try to get pregnant as soon as I got my period back. They said I should go on with my life and not dwell on cancer and the fear of recurrence.  They also want my ovaries out ASAP. The other half believed I should wait until the three-year recurrence peak for TNBC has passed. As one of them put it, it is already bad to have a recurrence and having it while pregnant would make it worse. He reminded us of how after the three years the chance of recurrence fell and so we would be less likely to face the tough decisions that families face when fighting cancer while pregnant. They also said that since I am still young waiting for a little while will not make much impact on my ovarian cancer risk.

 So it has not been easy for us to decide about when to do it. I used to joke by saying I would split the difference. But it has been already two years and a half since my surgery and at this point I think I want to play it safe and just wait another six months before I decide to try.

 I am a nerd; I have to admit it, I have always been one. As a cancer patient, this means that I try to research and learn about everything I am facing. Although my doctors have all said that it is safe for me to have more children, I have read and heard about PABC or pregnancy associated breast cancer. This has cast some doubts on my decision whether or not to have more children.

 Breast cancer is considered to be associated with pregnancy if diagnosed during a pregnancy or, as in my case, within a year following delivery[1]. Doctors at MD Anderson and other cancer centers have studied it closely as in PABC the rates of death from breast cancer are high. Recent studies have shown that this is mostly due to the fact that diagnosis during pregnancy is difficult as the breasts are too dense for mammograms and tests like PET Scans and similar are not recommended[2]. In these cases treatment is usually postponed until the fetus is able to take the chemo without problems or even until it can be safely taken out of the patient. Since these patients are usually young women whose cancer is usually pretty aggressive, any delays in diagnosis and treatment could affect their survival rates.

 The links between the pregnancy hormones and breast cancer are not yet fully understood. Just recently, several studies have shed some light on how the inflammation of the breast tissue that takes place during pregnancy affects the rate at which breast cancer grows[3].  Another recent study found that giving birth multiple times was related to an increase in the risk of developing triple negative breast cancer[4]. But this still doesn’t answer the question as to whether the pregnancy induces or causes the cancer. Also, the surge in hormones that pregnancy brings to a woman’s body may also promote the development of breast cancer. Although there are no definite studies showing a link between this surge in hormones during pregnancy and breast cancer, there are several studies showing that estrogen levels do affect the development of breast cancer even in hormone negative cases[5].

 BRCA status may also affect the risk of breast cancer associated with pregnancy. Some early studies showed that BRCA related breast cancer risk was associated with pregnancy[6]. But, other studies showed no definite association between pregnancy and BRCA related breast cancer risk[7]. More recent studies showed that the effect of pregnancy on the risk of breast cancer may differ between BRCA1 and BRCA2 mutation carriers at the data seemed to show that an increased number of pregnancies did increase the risk of breast cancer for BRCA2 mutation carriers but not for BRCA1 carriers[8].  Also, some studies have shown that estrogen does play a meaningful role in the development of breast cancer in BRCA1 mutation carriers. Some are even contemplating the use of hormone therapy as an alternative for breast cancer prevention for BRCA1 carriers even in hormone negative breast cancer cases[9].

 On the other hand, a recent meta-analysis that was published last year[10] looked at various studies that followed breast cancer survivors that had children after being diagnosed and treated and in general their survival rates were better than those of women who didn’t. In fact, doctors are currently studying the role that pregnancy hormones play in breast cancer, as they actually seem to prevent it, and there are ongoing clinical trials in which women are being given the hormones to prevent breast cancer[11]. There are no studies showing that a pregnancy after being successfully treated for breast cancer increases the chance of a recurrence[12]. Furthermore, what the studies on the subject seem to show is that pregnancy seems to offer some type of protection from a breast cancer recurrence[13].

 So far my research has not given me a definitive answer; I guess that science isn’t able to provide one yet. I am still undecided as to what to do and although so far none of my doctors have advised me against having another child I don’t want to have any regrets and I am still haunted by the fact that I found my cancer within a few months after giving birth. In the meantime, I am enjoying my little one and have actually found this time I’ve waited to have another one as a blessing, as I am being able to fully enjoy my child.  I have found that breast cancer is more than just a challenge itself as it brings many challenges along side. Fertility and parenthood are some of the ones that I have encountered along the way and as with the rest, I will try to educate myself as much as I can in order to make a decision that I can live with.

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[1] See http://www.medscape.com/viewarticle/711009, http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=48783

[2] See http://www.mdanderson.org/newsroom/news-releases/2009/m-d-anderson-study-finds-pregnancy-has-no-impact-on-breast-cancer-survival-does-delay-treatment-diagnosis.html

[3] See http://www.sciencedaily.com/releases/2010/03/100329162938.htm

[4] http://www.medpagetoday.com/HematologyOncology/BreastCancer/25071

[5] A couple of such studies can be found here:

http://www.sbs.utexas.edu/dharma/sigcancerpps/akt.pdf

http://www.tufts-mori.org/kuperwasser/Kuperwasser2062.pdf

[6] http://www.ncbi.nlm.nih.gov/pubmed/15040392

[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1797022/

[8]http://demo.cancerconsultants.com/Content.aspx?Section=cancernews&DocumentID=35259

[9] http://jnci.oxfordjournals.org/content/94/19/1504.2.full

[10] See http://www.hopkinsbreastcenter.org/artemis/201004/21.html

[11] See http://www.hopkinsbreastcenter.org/artemis/201001/28.html ; http://clinicaltrials.gov/ct2/show/NCT00808522?term=hcg+AND+breast+cancer&rank=1; http://clinicaltrials.gov/ct2/show/NCT00700778?term=hcg+AND+breast+cancer&rank=2 ;

[12] See for example  http://www.medscape.org/viewarticle/707303 and http://www.breastcancer.org/tips/questions/pregnancy.jsp

[13] http://www.medscape.org/viewarticle/707303

You CAN Survive Triple Negative Breast cancer

 Written by Patricia Prijatel on her blog, Positives About Negative, and posted on April 11, 2011.

Triple-negative breast cancer has caught the attention of major researchers throughout the world, which is a great thing—it means that we are learning more and more about how to prevent and treat this illness. The downside of the research popularity is that the media and medical journals have developed depressing and frightening catch phrases for it, such as deadly, particularly aggressive or, my favorite, a lethal triad. People who write these words do not realize that they can terrify the women who read them, hitting like a heavy thud on our hearts. Researchers are trying to define the disease. Patients are trying to beat it.

 The aggressive nature of hormone-negative is a comparative measure. That is, these cancers are, in general, more aggressive than hormone-positive cancers—although, in some cases, only slightly more aggressive. And some hormone-negative cancers can actually be less aggressive than some hormone-positive cancers. Scientists work in generalizations, defining how the disease affects women as a group. Individual cases vary and, researchers increasingly say, are as unique as our DNA.

 How researchers classify triple-negative, for example, can vary. My own case—negative for estrogen and her2, but weakly positive for progesterone—puts me in a fairly narrow subset. Yet I had two oncologists tell me that they classify weakly positive as a negative, meaning I would be triple-negative. Researchers disagree, usually considering any level of positive as being positive. It is possible, though, that my weakly positive progesterone put me in a less agressive subset that is so small it is seldom researched.

 So let’s look at some of the data and what they mean. And rather than simply accepting the gloomy picture that is often presented, let’s approach this in the enterprising spirit of yeah, but….

It is true that hormone-negative breast cancers can be more aggressive than hormone-positive. But the majority of women who get the disease survive.

 It is true that most cases of recurrence come within the first three years. But that means that those who hit five years are looking at an excellent prognosis. A better long-term prognosis, in fact, than those with hormone-positive.

 It is true that triple-negative is more likely to have spread to the lymph nodes. But many women with TNBC have no positive nodes—and, if they do, they still beat the disease and survive.

 I have learned to turn statistics around to improve my perspective. For example, when research says that 30 percent of the women with triple negative died in a particular study, I turn this around and realize that 70 percent of the women survived. And I plan to be one of those women. And if, in another study, a triple-negative woman faces a two-fold increased risk of death compared with hormone-positive, I look at the fact that the difference might be between a 10 percent risk of and a 20 percent risk. And, while those decreased odds are startling and sobering, they still can mean an 80 percent chance of not dying. Even starting with a poorer prognosis, the odds can still be with you.

 NOTE: This is an excerpt from the book I am writing on triple-negative breast cancer.

 

Breakthrough for TNBC

I recently returned from London, where I attended the Triple Negative Breast Cancer 2011 Conference hosted by Breakthrough Breast Cancer, a leading breast cancer research organization in the United Kingdom. Since its founding in 1991, Breakthrough’s researchers have been involved in some of the most ground-breaking developments in breast cancer, and they are now working on finding answers to some of the perplexing questions about triple negative breast cancer, most notably through the launch of a Triple Negative Trial which should be reporting preliminary results in 2012/2013. 

The Conference brought together over 200 scientists, research fellows and clinicians from all over the world to discuss many aspects of the TNBC puzzle- from cell biology to treatment protocol.  It was so ratifying for the Triple Negative Breast Cancer Foundation to be represented amongst this audience.  I spoke with many attendees who were unaware of the Foundation’s existence, but were so excited to hear about all that we are doing! 

One of the people I especially enjoyed meeting was Laura, a TNBC survivor from Romania, who is lucky enough to be able to have had her TNBC surgery, chemotherapy and radiation in the UK.  By her telling, she would never have been able to receive state-of-the -art treatment in her home country, and she wanted to give herself the best chance at surviving TNBC.  In the course of her diagnosis and search for information, she found the Foundation website and became connected to the forum- which she calls her “lifeline” – during the months of subsequent treatment.  How amazing that we are able to offer support and hope to someone halfway around the world!

Notes from San Antonio

While there was no “BIG NEWS” about triple negative breast cancer released at this year’s San Antonio Breast Cancer Symposium, there were several interesting and potentially impactful presentations and discussions.
Here are some highlights, taken from my notes:
Poster Session and Discussion on Metformin: Research is ongoing to demonstrate whether metformin, the most common medication used to treat type 2 diabetes, may also suppress breast cancer cell growth. Studies have found that diabetics who were treated with metformin were less likely to develop breast cancer than those who did not take the medication. Metformin may also have a positive effect on breast cancer outcomes, and that this effect may be more pronounced in TNBC.
Pamela Meiers and her colleagues at University of Toronto and Ying-Ka Lau at Columbia University presented posters that are exploring this connection that may prove to be important in the treatment of TNBC. Dr. Lau’s research involves the combination therapy of erlotinib (Tarceva) with metformin.
For more on metformin and its potential role in breast cancer, take a look at an article published by FORCE (Facing Our Risk of Cancer Empowered) in their Spring 2010 newsletter.
Lifestyle Factors and Breast Cancer: Again, there’s no earth-shattering news here, but the evidence continues to accumulate that obesity prior to a breast cancer diagnosis can mean a poorer prognosis. There is some debate amongst researchers about the role of fitness and weight loss as it relates to risk of recurrence and overall outcomes. Some evidence suggests that exercise and a lowfat diet with plenty of fruits and vegetables have more of an effect on outcomes than does weight loss. In the WINS study (Women’s Interventional Nutrition Study), 24% of the group who were randomized to follow a lowfat diet had a significant decrease in risk of recurrence. Other findings from the WINS study show better outcomes in the group that increased their physical activity.
In a related discussion about fitness, it was mentioned that many women are told that they should not practice upper-body strength training after surgery for breast cancer, out of concern about lymphedema. There is now evidence that slowly progressive strengthening of the upper body may be safe for these women. Katie Schmitz at the University of Pennsylvania and several others have shown that women participating in regular, slowly progressive weight exercise of the upper body had lower rates of lymphedema than women who exercised but did not do weight training.
The Upside of Irrationality- Dan Ariely, PhD
It’s uncommon for the SABCS to feature a non-MD in one of its plenary lectures. And it’s even rarer for those lectures to be centered around seemingly non-medical topics. But the plenary lecture given by Dan Ariely was just that. Dr. Ariely, the James Duke Professor of Psychology and Behavioral Economics at Duke University, has spent most of his career focused on how people make decisions on everything from their finances to their relationships with their healthcare providers. He became interested in the decision-making process while hospitalized for an extended period of time after being burned over 70% of his body in an accident. While being treated, he noticed that the nurses were making “intuitive decisions” about how much pain he was suffering. While they were trying to help him, in fact these decisions were based on incorrect intuitions, and they were causing him great pain and suffering.
Even in processing basic things which can be seen with our own eyes, our brains are filtering information which may be affected by external factors which lead to incorrect conclusions. Decisions are affected by the environment in which we make them, and this environment is often out of our own control. We are also affected in our decision-making by how complicated the decision is. In fact, Dr. Ariely showed, because of this, we often make decisions that are easier for us, not better for us.
How does this relate to the relationship a patient has with their doctor? Patients are asked to make difficult decisions under difficult conditions, often under time constraints, and often with limited information about outcomes and options. The doctor may not always appreciate how complex these decisions are for the patient, or that the patient may not have sufficient knowledge to make good decisions. Faced with what seems to be an overwhelmingly complex process, a patient may choose the easiest option- the example Dr. Ariely gave was a choice between mastectomy or a course of neoadjuvant therapy which might allow for more conservative surgery- but not necessarily the best option for them.
With the array of choices patients have at many points along their treatment continuum, Dr. Ariely recommended that doctors consider how to best support the patient in making decisions. With advocacy and patient-centered care being important buzz words now, it is imperative for the doctor to include the patient in a way that is meaningful to the patient. He closed his short but impactful lecture to his captivated audience of healthcare providers with the caution, “Doubt your intuitions; be willing to try different things.”
Dr. Ariely is the author of Predictably Irrational: The Hidden Forces that Shape our Decisions and The Upside of Irrationality: The Unexpected Ways We Defy Logic at Work and at Home.

LIVE FROM THE TNBC SYMPOSIUM IN SAN ANTONIO

Today over 40 leading researchers in TNBC convened in San Antonio for the 4th annual TNBC Symposium.  They will spend the day actively discussing the state of research activities and how they can move the research agenda more efficiently and, hopefully, more quickly.  The Symposium is an opportunity for the researchers to speak openly with each other about the challenges and (sometimes) the missteps that research on TNBC often poses. Ultimately, the results of the day’s proceedings can set the tone for future explorations and for collaborations across institutions and disciplines that bring us new discoveries and hope.

One of the attendees told me that the Symposium was “the best meeting I go to the entire year”, which is tremendous praise!