Chemicals And Additives To Avoid
Many chemicals used in agriculture, body care products, food packaging and plastic water bottles are estrogenic, called xenoestrogens or estrogen mimics. In addition to binding with estrogen receptors, these toxins are fat soluble, so they tend to accumulate in fat cells. We know that breast tissue has a high concentration of fat, particularly after menopause. Studies have shown that breast milk often contains dangerous levels of these chemicals. Reduce exposure by avoiding plastic food and beverage containers, canned foods, and body products with these common chemicals. For a list of chemicals to avoid, visit the Environmental Working Group site.
Breast Cancer Recurrence Risk Lingers Years After Treatment Ends
Steady rates of recurrence in women with estrogen receptor-positive disease could influence decisions about long-term therapy.
Even 20 years after a diagnosis, women with a type of breast cancer fueled by estrogen still face a substantial risk of cancer returning or spreading, according to a new analysis from an international team of investigators published in the New England Journal of Medicine.
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Standard treatment for estrogen receptor-positive, or ER-positive, breast cancer includes five years of the endocrine-based treatments tamoxifen or aromatase inhibitors, both of which are taken daily as a pill.
Researchers from the Early Breast Cancer Trialists Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy.
Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.
Even though these women remained free of recurrence in the first five years, the risk of having their cancer recur elsewhere from years five to 20 remained constant, says senior study author Daniel F. Hayes, M.D., Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center.
Is Her2 Breast Cancer Curable
The chances of successfully treating HER2 breast cancer is high if the cancer is detected in early stages. HER2 cancers, however, are often high grade tumors in stage III at the time of diagnosis. If HER2 cancer has metastasized at the time of diagnosis, it is treatable but not curable in most individuals.
With the development of medications that specifically target HER2 proteins, HER2-positive breast cancers now have a much better outlook than in the past. HER2-positive cancers that have been in remission for five years are less likely to recur.
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What Does It Mean To Have Stage 1 Breast Cancer
In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.
Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.
How Is Tnbc Diagnosed
Imaging tests are usually the first tests done:
- Mammography, the most common screening tool for breast cancer, uses X-rays to take images of the breast and can uncover tumors that may be too small to feel.
- MRI uses a magnet, radio waves and a computer to make detailed images of the breast with a much greater resolution than a mammogram offers.
The next step is a biopsy to remove a sample of suspicious cells from the breast to analyze them. Techniques include:
The appropriate type of biopsy for you depends on factors such as the size and location of the tumor. You may also have a biopsy of your underarm lymph nodes at the same time to see if any cancer is there.
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Should I Enroll In A Clinical Trial
Clinical trials are definitely worth considering, according to the Susan G. Komen organization. They offer the chance to try and possibly benefit from new treatments. The best time to join a trial is before starting treatment or, if your provider is considering changing treatments, before you switch to a new treatment. Ask your doctor if there are any trials that would suit your circumstances. You can also search the clinical trial database at ClinicalTrials.gov or use the Susan G. Komen Metastatic Trial Search, a personalized tool to match you with clinical trials.
Predictors For Os And Bcss By Multivariate Cox Regression Analysis
Compared with ER+PR+HER2-, patients with ER+PR-HER2-, ER-PR+HER2-, and ER-PR-HER2- were associated with compromised OS with HR of 1.67 , 2.36 , and 2.72 , respectively. In addition, ER+PR-HER2+ and ER-PR-HER2+ were associated with compromised OS compared with ER+PR+HER2- with HR of 1.20 and 1.27 , respectively. However, patients with ER+PR+HER2+ showed marginally better OS than those with ER+PR+HER2-with HR of 0.93 . No significant difference in OS was observed between patients with ER+PR+HER2- and ER-PR+HER2+ . BCSS showed the same trend as OS. In addition, patients with ER+PR+HER2+ showed improved BCSS compared with ER+PR+HER2- cases with HR of 0.89 .
Table 2 Overall survival by multivariate Cox proportional analysis.
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A Disease No One Gets
Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.
âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â
The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.
Minimize Exposure To Heavy Metals
Heavy metals including copper, cobalt, arsenic, cadmium, mercury and lead have been found to stimulate estrogen receptors. Sources of arsenic include some brands of rice, seafood, well water cadmium is high in cigarettes and can be found in some soils mercury is mainly prevalent in larger fish and old dental amalgams and lead contamination is a component of air pollution, paint and dyes, and ceramic glazes among other sources.
Essentially, heavy metal and toxin exposure is hard to completely avoid in our world, even with careful choices. Because of this, I advise my patients to use compounds that provide safe, gentle detoxification of heavy metals and other contaminants, on a daily or periodic basis.
Modified citrus pectin, is derived from the pith of citrus fruit and has been shown in human studies to remove harmful heavy metals and reduce toxic body burden over time. MCP is able to cross the intestinal barrier and circulate in the bloodstream, where it binds to toxins and heavy metals and helps safely excrete them, without removing essential minerals. I also recommend ingredients such alpha-lipoic acid, N-acetyl cysteine, garlic, cilantro and other herbs and nutrients that provide support for our bodys complex detoxification systems.
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Summary Of Treatment Options For Metastatic Breast Cancer
Hormone receptor-positive, HER2-negative breast cancer
Hormonal therapy is considered the standard initial treatment for HER2-negative metastatic breast cancer that is also hormone receptor-positive, and is often given in combination with targeted therapy. However, chemotherapy may also be given. A clinical trial may also be an option for treatment at any stage.
Hormone receptor-negative, HER2-negative breast cancer
In general, chemotherapy or targeted therapy is given for treatment of triple-negative breast cancer. A clinical trial may also be an option for treatment at any stage.
HER2-positive breast cancer that has spread to parts of the body other than the brain
In general, HER2-targeted therapy is regularly added to treatment for HER2-positive breast cancer that has spread. The drugs used depend on the treatments already given and whether the cancer is hormone receptor-positive. The treatment recommendations for first-line, second-line, and third-line or higher treatment are listed below. A clinical trial may also be an option for treatment at any stage.
Second-line treatment is used for people with early-stage breast cancer who had the cancer either spread during initial treatment with trastuzumab or return within 12 months after stopping treatment with trastuzumab. It is also used for people whose cancer worsens while receiving first-line treatment.
The preferred second-line treatment is the drug T-DM1.
Being Your Own Advocate
While there aren’t currently any studies looking at self-advocacy and survival, being your own advocate can’t hurt in maximizing your survival. Oncology is changing rapidly and it’s difficult for any oncologisteven those who specialize in breast cancerto stay aware of all of the latest research and clinical trials taking place.
It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.
Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.
There are ways to learn about opportunities, however, that don’t require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.
Several of the larger cancer centers are now also offering remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about whether there are any opportunities for treatment for you that may not be available elsewhere.
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Breast Cancer Hormone Receptor Status
Breast cancer cells taken out during a biopsy or surgery will be tested to see if they have certain proteins that are estrogen or progesterone receptors. When the hormones estrogen and progesterone attach to these receptors, they fuel the cancer growth. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors . Knowing the hormone receptor status is important in deciding treatment options. Ask your doctor about your hormone receptor status and what it means for you.
What Is My Estrogen Receptor And Progesterone Receptor Status
Your bodys hormones such as estrogen and progesterone may play a role in how your breast cancer progresses.
Normal cells are equipped with receptors that allow them to receive information from circulating hormones, similar to the way your phone picks up satellite signals. Cancer cells may also have hormone receptors, letting them tap into your bodys normal cell growth-regulating system.
Your ER/PR status is determined by testing a sample of breast cancer cells removed during a biopsy. If your breast cancer cells have estrogen and progesterone receptors if theyre ER/PR-positive then theyre capable of detecting estrogens signal and using it to fuel growth. If the cancer cells lack these receptors meaning theyre ER-/PR-negative they cant hear the growth-signaling message.
About 70% of breast cancer patients have positive ER/PR hormone status.
While being ER/PR-positive sounds bad, theres actually a benefit. Doctors can take advantage of the receptors presence. They can use an anti-estrogen drug that blocks the receptors and blocks estrogens growth signal. Or they can use other drugs like aromatase inhibitors that lower your bodys estrogen levels to deprive the cancer cells of fuel.
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Is Stage 1a Breast Cancer Curable
Although the majority of women with Stage I breast cancer are cured following treatment with surgery and radiation, some patients may benefit from additional treatment with chemotherapy and/or hormonal therapy. Treatment after surgery is called adjuvant therapy and it may further decrease the risk of cancer recurrence.
Dos And Donts For Estrogen
Breast cancer is not just one disease it comes in many variations.
One of the primary factors in determining the type of breast cancer is the sensitivity of the tumor cells to estrogen. If a breast tumor is hormone-sensitive or estrogen receptor-positive, it means there are specific estrogen receptors on the tumor cells, and when estrogen binds with these receptors, it transfers a message to the cancer cells. Like a lock and key effect, the breast tumor cells are stimulated by estrogen to grow and reproduce. Therefore, one of the main goals of therapy or intervention with hormone-positive cancer is to reduce hormonal stimulation as much as possible.
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From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
Ã¢They used the C-word with me, they told me I was cured,Ã¢ she said. Ã¢Every time I went back to my oncologist, he would roll his eyes at me when I had questions.Ã¢
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered PollastroÃ¢s cancer had metastasized to her liver.
Ã¢My husband and I were in shock,Ã¢ said Pollastro of her mets diagnosis. Ã¢You donÃ¢t go from being cured to stage 4.Ã¢
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
Ã¢I felt better right away with the treatment,Ã¢ she said. Ã¢But the problem is, it stopped . ThatÃ¢s what you can expect with mets. And thereÃ¢s always some residual cancer. And that starts percolating.Ã¢
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
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What Are The Treatment Options For Er
In addition to surgery, treatments for ER-positive breast cancers include:
- Targeted therapies
Burstein says there has been a sea change in the use of chemotherapy for early-stage ER-positive breast cancer, thanks to tests of the genomic characteristics of a tumor and which allow the majority of women to avoid chemotherapy.
For premenopausal women with early, low-risk breast cancers, there is growing recognition that ovarian suppression rather than chemotherapy is an important treatment to reduce the chances of recurrence. Chemotherapy is indicated, however, for women with larger ER-positive tumors with higher-risk genomic features.
Endocrine therapy for five to 10 years, to prevent metastatic disease, recurrence, and tumors in the opposite breast, is recommended for almost all patients with ER-positive breast cancer. Previously, tamoxifen was the standard endocrine therapy, but in recent years, there have been more options, such as aromatase inhibitors, which are more effective than tamoxifen, especially in higher-risk cancers. Endocrine therapy is also standard treatment for metastatic disease.
All the endocrine therapies carry some risks and have side effects. Bursteins review notes that better understanding of these side effects and how to manage them can help providers individualize therapy for patients.
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What Are The Categories Of Breast Cancer
Breast cancers are categorized into the following groups based on the hormone receptor and HER2 status:
- Luminal A: ER and PR positive, and HER2 negative breast cancer
- Luminal B: ER positive, PR negative and HER2 positive breast cancer
- HER2 positive: HR negative and HER2 positive breast cancer
- Triple positive: ER, PR and HER2 positive breast cancer
- Triple negative : HR and HER2 negative breast cancer
Aol Distant Recurrence Calculation
An adjustment to AoL was required in order to compare the estimated residual risk of distant recurrence at 10 years between AoL and IHC4+C. As previously described the AoL residual risk of breast cancer recurrence was calculated using the AoLs estimate of breast cancer mortality at 10 years and subtracting the estimated benefit of 5 years of endocrine therapy, leaving the 10-year breast cancer-specific mortality. This was then multiplied by 1.25, to account for only the distant recurrence events ).
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Determining Your Her2 Status
A breast biopsy is used to determine HER2 status. The biopsy can be sent for laboratory testing with an immunohistochemistry test. The fluorescence in situ hybridization test looks for the HER2 gene in breast cancer cells.
The results of an immunohistochemistry test show different levels of HER2 positivity. For example, a tumor may be reported as 0, 1+, 2+, or 3+. Tumors with a higher number may be referred to as having an overexpression of HER2.
According to the American Cancer Society, immunohistochemistry test results should be considered as follows:
The impact of being HER2-positive on breast cancer survival is, of course, a top concern. Unfortunately, statistics can be misleading without considering other aspects of your diagnosis, including cancer stage at diagnosis and whether the tumor is also estrogen and/or progesterone receptor-positive.
With this in mind, you may also be tested for progesterone and estrogen receptors. Triple-negative breast cancers are negative for HER2, estrogen, and progesterone, while triple-positive breast cancers are positive for all three.
Is The Cancer In My Lymph Nodes
Whether your breast cancer has spread to your lymph nodes the filtering mechanisms in your armpits and elsewhere in the body that are part of the immune system is one of the most important predictors of the severity of your disease.
Involvement of the lymph nodes changes the treatment plan, says Dr. Abraham. When breast cancer cells have spread to the lymph nodes, we tend to discuss more aggressive treatment options, such as chemotherapy.
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