Moving Genomic Testing Into Practice
This study is a big deal, said Dr. Timothy Byun, a medical oncologist with The Center for Cancer Prevention and Treatment at St. Joseph Hospital in Southern California, who was not involved in the study.
In an interview with Healthline, Byun said the study may result in fewer breast cancer patients getting chemotherapy, at least in European countries.
In the United States, many of us have already been using the Oncotype DX test to help guide our decisions, said Byun. It uses a 21-gene score. It gives similar information, but we dont know if theres a 100 percent correlation with the MammaPrint test.
Byun referred to the recent TAILORx Trial using the 21-gene test. It found that low-risk patients did well without chemotherapy.
That study showed the test could select a cohort of patients with a 99 percent chance of five-year survival without distant metastasis. For those women, the risks of chemotherapy arent justifiable.
Researchers are still waiting for this data to mature, cautions Byun.
We know that when oncologists see patients after surgery, we look at traditional clinical indicators to guide our decision-making process as to benefits and harms of chemotherapy, he said.
With the information currently available, its likely that some breast cancer patients get unnecessary chemotherapy.
Theres a caveat, according to Byun. Genomic studies, for the most part, have included only estrogen-receptor positive breast cancer patients.
Cancer Treatments That Arent Chemotherapy
Cancer experts at Rush discuss cancer treatments, including surgery and immunotherapy
What are some words you associate with cancer? Chances are chemotherapy is one of the first that comes to mind. But chemo is not always the first course of treatment.
These days, a cancer diagnosis doesnt have to mean chemo and the nausea, vomiting and hair loss most people think of, says Susan Budds, NP, a nurse practitioner who specializes in cancer at Rush.
In fact, sometimes chemo takes a back seat to other treatments that may have milder side effects. Thanks to new treatments and advances in personalized care, oncologists are now better able to tailor cancer treatment to each individual patient and the type of cancer they have.
Treatment For Breast Cancer May Cause Side Effects
Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.
Late effects of radiation therapy are not common, but may include:
- Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
- Arm lymphedema, especially when radiation therapy is given after lymph node dissection.
- In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.
Late effects of chemotherapy depend on the drugs used, but may include:
Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:
- Heart problems such as heart failure.
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What Is Breast Cancer
Breast cancer is the most common cancer in women in Australia and the second most common cancer to cause death in women, after lung cancer.
Breast cancer is the abnormal growth of the cells lining the breast lobules or ducts. These cells grow uncontrollably and have the potential to spread to other parts of the body. Both men and women can develop breast cancer, although it is uncommon in men. Transwomen, non-binary people can also get breast cancer.
Transgender and gender-diverse people can also get breast cancer. A transgender woman taking medication to lower male hormones and boost female hormones may have an increased risk of developing breast cancer.
It is estimated that 19,866 women and 164 men in Australia will be diagnosed with breast cancer in 2021.
In Australia, the overall five year survival rate for breast cancer in females is 91%. If the cancer is limited to the breast, 96% of patients will be alive five years after diagnosis this figure excludes those who die from other diseases. If the cancer has spread to the regional lymph nodes, five year relative survival drops to 80%.
Treatment depends on the extent of the cancer.
Why Most Women Can Beat Breast Cancer Without Chemo
Chemotherapy has some devastating side effects. Nausea, fatigue, hair loss, fever and bowel problems are just the start. Chemotherapy can also cause anemia, nerve and muscle problems, skin breakdown and mood changes.
Heart arrhythmias and a weakened cardiac muscle leave chemotherapy patients more vulnerable to heart attacks.
For most women who have been diagnosed with breast cancer, radiation and chemotherapy have been the standard of care.
That is, until recently.
Since 2006, the American and Canadian governments have quietly been funding research aimed at sparing thousands of women each year the unnecessary ordeal of chemotherapy for breast cancer.
Twelve years later, their efforts have borne fruit.
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Axillary Lymph Node Dissection
If the cancer has spread to the glands, all the glands under the arm will need to be removed. Unfortunately, this can cause some pain and stiffness around the arm after the operation and in 1 out of 10 ladies, the arm may swell up after the operation , because there is no longer a clear passage for fluid to flow from the arm back to the body. Most often an axillary dissection is done at the same time as the breast operation, through the same cut or a different one. If the sentinel lymph node biopsy is negative however, an ALND may not be required.
New data suggests that some women may not need to have an ALND, even if their glands are positive for cancer. This may change surgical practice in the future, but at present further research is required.
Advances In Conventional Breast Cancer Treatment
Early-stage, localized breast cancer is highly treatable, but not everyone is aware that cancer treatment in general has evolved and improved in the last few years. Advances in breast cancer treatment have improved patient outcomes while also reducing side effects patients may experience during treatment. Below are a few of the most promising developments.
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Reasons To Refuse Treatment
Most people would consider it “normal” to want to seek treatment for breast cancer the moment you are diagnosed, particularly at a time where survival rates are ever-increasing. But this would also infer that not seeking treatment is “abnormal,” and that’s rarely the case.
There are a plethora of reasons why a woman may not be willing to pursue or continue breast cancer treatment. Some may be transient and fade with time. Others are fully committed and made with a complete understanding of the implications of the refusal.
Among some of the more common reasons for the refusal of breast cancer treatment:
According to research from Canada, the majority of women who refused breast cancer therapy were over 50 , married , and had metastatic disease . Of these, 50% reported using some form of complementary or alternative medicine.
Rejecting Cancer Treatment: What Are The Consequences
There have been several studies of people who have refused scientific treatments for cancer. The results have not been good.
These do not cure cancer
One of the points Ive tried to emphasize through my contributions to Science-Based Medicine is that every treatment decision requires an evaluation of risks and benefits. No treatment is without some sort of risk. And a decision to decline treatment has its own risks. One of the challenges that I confront regularly as a pharmacist is helping patients understand a medications expected long-term benefits against the risks and side effects of treatment. This dialogue is most challenging with symptomless conditions like high blood pressure, where patients face the prospect of immediate side effects against the potential for long-term benefit. Ones willingness to accept side effects is influenced, in part, by and understanding of, and belief in, the overall goals of therapy. Side effects from blood-pressure medications can be unpleasant. But weighed against the reduced risk of catastrophic events like strokes, drug therapy may be more acceptable. Willingness to accept these tradeoffs varies dramatically by disease, and are strongly influenced by patient-specific factors. In general, the more serious the illness, the greater the willingness to accept the risks of treatment.
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Treatments For Breast Cancer
If you have breast cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for ductal carcinoma and lobular carcinoma, your healthcare team will consider:
- the stage
- if you have reached menopause
- the hormone receptor status of the cancer
- the HER2 status of the cancer
- the risk that the cancer will come back, or recur
- your overall health
Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
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Treatment Of Breast Cancer
KAREN L. MAUGHAN, MD MARK A. LUTTERBIE, MD and PETER S. HAM, MD, University of Virginia School of Medicine, Charlottesville, Virginia.
Am Fam Physician. 2010 Jun 1 81:1339-1346.
Breast cancer is the second most common cause of cancer mortality in women in the United States.1 One in eight women will be diagnosed in her lifetime.2 Breast cancer treatments continue to evolve, and although family physicians do not generally make primary decisions about these therapies, understanding their rationale and underlying evidence can help with the care of their patients during and after cancer treatment. Table 1 lists the five-year survival prognosis for each stage of breast cancer.3,4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Breast-conserving surgery should be followed by radiation therapy in women with early-stage invasive or locally advanced breast cancer.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Breast-conserving surgery should be followed by radiation therapy in women with early-stage invasive or locally advanced breast cancer.
Breast Cancer Five-Year Survival by Stage at Diagnosis
Inflammatory breast cancer may be stage IIIb, IIIc, or IV.
Are There Ways To Prevent Hair Loss With Chemotherapy
Not everyone loses hair when receiving chemotherapy, but many people do. Some peoples hair only thins. Others lose the majority or all of their hair.
Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.
People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a cranial prosthesis or hair prosthesis. Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.
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What Kind Of Treatment Follow
The major goal of follow-up is, if possible, to detect and treat recurrences in the irradiated breast or lymph nodes and new cancers developing later in either breast before they can spread to other parts of the body. Theroutine use of bone scans, chest x-rays, blood tests and other tests to detect the possible spread to other organs in patients without symptoms does not appear to be useful. Your physician will determine a follow-upschedule for you. This may include a physical exam every few months for the first several years after treatment and then every six to 12 months or so after that. Annual follow-up mammograms are an important part of your care. If symptoms or clinical circumstances suggest a recurrence, diagnostic tests such as blood tests, ultrasound,computed tomography , magnetic resonance imaging , chest x-ray , or bone scan may be needed.
Outcomes Of Breast Cancer In Patients Who Use Alternative Therapies As Primary Treatment
This was a medical chart review by Chang et al, published in the American Journal of Surgery in 2006. It examined breast cancer patients who refused conventional chemotherapy, or delay its initiation, in order to use CAM. The authors calculated each patients prognosis at the time of diagnosis. In total, 33 women were included. The results were grim:
- Eleven patients initially refused surgery. Ten of these patients experienced progressive disease. Five ultimately had surgery. In the six others, the cancer had already metastasized, so surgery would have offered no benefit.
- Three patients refused to allow sampling of lymph nodes to evaluate disease spread. One of these patients developed recurrent disease in the lymph nodes.
- Ten patients refused local control of the tumor site. Two patients developed recurrences in the same location, and two developed metastatic disease.
- Nine patients refused chemotherapy, raising their estimated 10-year mortality from 17% to 25%
Consistent with the study above, the vast majority of breast cancer patients who refuse surgical intervention developed progressive disease. Even delaying surgery increased risks and overall mortality. Outcomes were better for patients that accepted surgery, but refused adjuvant treatments, like chemotherapy. However, even this strategy significantly raised 10-year mortality estimates.
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Treatment : Targeted Therapies
Oncologists use targeted therapies, also known as precision medicine, to tailor medications for each individual patient and cancer. A tumor or blood sample is tested to identify a genetic profile. That allows clinicians to administer medication that targets the genes that are causing the cancer.
There could be five or six gene processes that turn a cancer on or off, Budds says. With genetic testing, we can find out which medicines to use and which ones not to use.
Medications, delivered in pill or IV form, either destroy cancer cells or stop the cancer from continuing to grow. Like immunotherapy, targeted therapies can be used at any stage: as a first treatment, to keep the cancer from coming back or if a cancer returns.
For instance, patients with breast cancer are typically tested to see if they carry the HER2 gene, which can play a role in causing breast cancer cells to grow. If a patient tests positive for HER2, oncologists at Rush use a medication or a combination of medications developed to target the gene, such as trastuzumab or pertuzumab. These medications help stop the growth of the cancer cells, often without harming healthy cells.
Natural Breast Cancer Treatment Vs Conventional Treatment: What Patients Need To Know
If youre like most women whove recently received a breast cancer diagnosis, youre probably trying to learn everything you can about your treatment options and the range of potential side effects. You may recall friends or family members who had a difficult experience with chemotherapy, radiation therapy or surgery for breast cancer. What youve read about side effects may sound unpleasant and scary. Many women wonder whether natural or alternative treatments for breast cancer could work for them instead.
It’s normal to want to explore all your options, particularly if youre concerned about the side effects of conventional breast cancer treatment. Friends or family may even recommend that you try certain alternatives, like salves or vitamin infusions, instead of conventional treatment. On the other hand, your loved ones may be alarmed if youre considering rejecting conventional treatment altogether.
Patients sometimes come to us for a second opinion for breast cancer after having tried to treat their cancer with alternative therapies. Others ask questions, like:
- Will chemotherapy kill all the healthy cells in my body?
- Will changing my diet help?
- Can I apply a salve to make the cancer go away?
- Can we use medical marijuana to treat cancer?
- Can IV infusions of vitamin C or other nutrients cure cancer?
To help you navigate your breast cancer treatment options, this article will cover:
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Why Are Lobular Cancers Sneaky
Instead of clustering together, lobular cells spread out single file like tree branches or spider webs or mesh, which explains why surgeons and oncologists often refer to it as sneaky or insidious. Because the cells don’t stick together well, there’s often no lump, making it harder for women to find during self- …
Can Breast Cancer Be Treated What Treatments Are Available
If you or someone you love is diagnosed with Breast Cancer the chances are you have to spend a lot of time in different doctors offices, and all the doctors will discuss different types of treatments.
Breast Cancer management relies on a firm foundation of a multidisciplinary team. What that means is that every doctor involved in cancer treatment should be speaking to every other doctor. The intention is that from the start of a patients treatment there is an individual plan, tailored to the exact stage and type of Breast Cancer that the patient has. This team of people involved in care includes the breast surgeon, the reconstructive surgeon, a radiologist who carries out mammograms and biopsies, the chemotherapy and radiation specialists as well as a psychologist and survivorship specialist. The most important person is the patient navigator usually a nurse whose role is to ensure that the patient and family has support and guidance along all aspects of treatment.
Breast Cancer management does not only involve the breast, but treatment of the whole body.
Therapies can be divided into those that affect the breast, to get rid of the cancer present in the breast, or in the nearby lymph glands, and those therapies that seek out and destroy breast cancer cells that may be present elsewhere in the body.
The therapies are:
Local treatments to the breast
Whole body treatments to find any cancer that has spread in the body:
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