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Preventing Recurrence Of Triple-negative Breast Cancer

Be Mindful Of Your Environment Including Household Chemicals

1st phase of breast cancer vaccine trial begins

It’s long been suspected that environmental exposures, including the chemicals we are exposed to in everything from household cleaners to cosmetics, may play a role both in breast cancer risk and recurrence. While it’s difficult to study , we are learning that practicing caution is wise.

A 2017 review looked at the evidence to date connecting breast cancer and the environment. Some compounds, such as PCBs , may raise the risk of recurrence. Others may alter the regulation of genes involved in cell growth, apoptosis , and much more. Endocrine disrupting chemicals can mimic the function of hormones in our bodies, and it’s well known that the hormone estrogen should be avoided to reduce breast cancer recurrence, at least for people with hormone positive tumors.

There is a great amount of information out there of varying degrees of concern, but the important thing to note is that it’s relatively easy to avoid concerning chemicals . Most household cleaners can easily be replaced with baking soda, lemon juice, and vinegar .

The environmental working group has a website where you can search on thousands of personal care products . And adding a few houseplants to your home can help to absorb many indoor air carcinogens with indoor air thought to be more of a concern that outdoor air pollution.

How Does The Vaccine Work

The vaccine targets a milk protein called alpha-lactalbumin, or a-lactalbumin. Sometimes referred to as a retired protein, its not usually found in the tissues of nonlactating people. But it does occur in most cases of TNBC.

The hope is that the vaccine, also called the aLA breast cancer vaccine, will work much like vaccines that cure infectious diseases. That is, it will stimulate the bodys immune system to clear this specific type of cancer.

The idea is to teach the immune system to clear out cells that express a-lactalbumin. In theory, this will prevent tumors from forming.

In the current phase 1 trial, researchers aim to determine the maximum tolerable dose. Participants will get 3 vaccinations in varying doses, 2 weeks apart.

How Is Triple Negative Breast Cancer Diagnosed

The first step might be a mammogram to evaluate a suspicious mass or lump in your breast. Based on what they learn, healthcare providers might perform a biopsy to remove breast tissue. Then they examine the tissues cells to determine the cancer subtype. Identifying the cancer subtype is part of the staging process, which is when providers decide how to treat your cancer.

Sometimes providers use the following tests before treatment to check on your tumors size and whether it has spread, or after treatment to monitor response to treatment:

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What Is The Recurrence Rate Of Triple

A 2019 study found that roughly 40% of people with stage 1 to stage 3 TNBC will see their cancer return after standard treatment. The remaining 60% will have long-term survival without recurrence.

The outcomes of treatment vary. About 42% of those with this form of cancer will have a rapid relapse after standard treatment. This recurrence typically occurs within the first 23 years following the initial diagnosis.

It is not currently possible to predict who will experience a relapse in their cancer, even if they have had intensive chemotherapy.

On average,

Triple-negative breast cancer can recur in various areas of the body and at local, regional, and distant levels:

  • Local means that the cancer remains in the breast and has not spread.
  • Regional is when the cancer spreads from the breast to lymph nodes and other structures located nearby.
  • Distant refers to cancer that has spread far from the breast to other organs, such as the liver or lungs.

A 2017 study examined the patterns of recurrence among 1,930 people with TNBC. The researchers divided the patients into two age groups: 15% were younger than 40 years at the time of their diagnosis, and 85% were 40 years or older.

The researchers found only a small difference between the two groups in terms of recurrence of the cancer on the local level: 6% of those under 40 versus 5% of those aged 40 or above.

The same study found that the rate of regional recurrence was 2% for both groups.

Advances In Treatment Of Tnbc

Breast cancer

TNBC has a high probability of recurrence within the first 3 years after diagnosis, and when it spreads it often involves visceral organs, such as the lung, liver, and brain. With this aggressive behavior and short survival once it becomes metastatic, developing optimal therapeutic strategies for the treatment of early TNBC is crucial to prevent recurrence. In the past decade, extensive efforts have been made to find new therapeutic targets of TNBC based on its molecular structure. At this time, no targeted agents are approved in the curative or early setting.

However, exhaustive research efforts are underway to identify novel therapeutics for both early and advanced disease. Just last year, atezolizumab, an immunotherapy drug, was approved in conjunction with a standard chemotherapy for the initial treatment of metastatic TNBC. This therapy showed a longer survival for women who received the immunotherapy combined with nab-paclitaxel compared with nab-paclitaxel alone. Clinical trials are integral not only for the treatment of patients today but also to improve the available therapies for patients to come.

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Diagnosing Triple Negative Breast Cancer

In many women the cancer is found during breast screening. But symptoms such as a breast lump can be a sign of breast cancer. So it is important to get any symptoms checked by your doctor.

If you have symptoms and see your GP they refer you to a specialist breast clinic. At the breast clinic the doctor or breast care nurse takes your medical history and examines your breasts. They also feel for any swollen lymph nodes under your arms and at the base of your neck.

You have some of the following tests:

  • a biopsy your doctor or nurse take a small sample of cells or tissue from your breast to look at under a microscope

Depending on your age and whether other family members have had breast cancer, your doctor might refer you for gene testing. This is to find out if there is a fault in the BRCA cancer gene.

Have Your Vitamin D Level Checked

While there has been some controversy over vitamin D levels and breast cancer, some studies have found that people assigned female at birth who have low 25-hydroxyvitamin D levels have a higher recurrence risk. The benefits of vitamin D, however, go beyond reducing recurrence, and getting adequate vitamin D may improve your quality of life while living with breast cancer.

Many people ask about whether or not they should use a supplement, but fortunately, a simple blood test can determine your levels, and whether they are deficient, low normal, or adequate.

Even if the laboratory range for vitamin D at your cancer center is wide , some researchers believe a level of 50 or greater is optimal in those who have had cancer.

Getting vitamin D via dietary sources is challenging, at least to get the optimal 2000 IU/day recommended by some .

Sunshine is also a source of vitamin D, though excess sun exposure is important to avoid for other reasons. .

If a healthcare provider recommends a supplement, it’s important to purchase a good product to reduce your mercury exposure. And, too much of a good thing is not better. One potential side effect of taking excess vitamin D is painful kidney stones.

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Risk Factors For Triple

Doctors aren’t sure what makes you more likely to get triple-negative breast cancer. Not many women do — it only affects up to 20% of those who have breast cancer. You’re most at risk for triple-negative breast cancer if you:

  • Are African-American or Latina
  • Have what your doctor will call a BRCA mutation , especially the gene BRCA1

A Note About Statistics

Predicting disease recurrence in patients with early triple-negative breast cancer using circula…

Survival rates are statistics. As such, they tend to tell us how the average person will do with an average triple-negative breast cancer. But people and tumors arent statistics. Some people will do better, and some people will do worse.

Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior, and there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.

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Antioxidant Action Of Polyphenolics

Polyphenols are secondary metabolites of plants and are generally involved in defense against ultraviolet radiation or aggression due to their physiological effects and structure . Many of the biological actions of polyphenols have been attributed to their antioxidant properties however, recent research has suggested that polyphenols may affect several cellular pathways, thereby exerting a pleiotropic effect . Cellular pathways initiated by polyphenols may delay and reduce the carcinogenic processes in breast tissue . Oxidative stress is known to alter the cellular redox status, resulting in altered gene expression by the activation of several redox-sensitive transcription factors. This signaling cascade affects both cell growth and cell death. An increased rate of reactive oxygen species production occurs in highly proliferative cancer cells, owing to oncogenic mutations that promote aberrant metabolism. The ability of dietary polyphenols to modulate cellular signal transduction pathways, through the activation or repression of multiple redox-sensitive transcription factors, has been claimed for their potential therapeutic use as chemo-preventive agents .

Polyphenols Protect Dna From The Carcinogen

Chronic activation of inflammatory processes is widely regarded as an enabling characteristic towards the development of cancer. We know that chronic inflammation can drive tumour growth and the production of ROS . In turn, ROS can cause DNA damage. Production of ROS, together with deficiencies in the capacity to repair DNA , can interact to increase carcinogenic capabilities . Base-excision repair genes, such as XRCC1 G399A and OGG1 C326G, are associated with reduced repair of DNA lesions associated with ROS .

The mutagen sensitivity assay can be used as a marker of the ability of DNA to respond to and repair DNA damage and hence it has been used to test response to mutagens and bioactives . The Comet and Micronucleus assays have also been extensively used to determine the extent of DNA strand breaks and repair , and there are a number of other methods, including RAD1 focus formation , PCR, and the TUNEL assay, as well as numerous others .

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Giving Hope To Patients With Triple

Triple-negative breast cancer is usually treated with some combination of surgery, radiation therapy, and chemotherapy. Unlike other subtypes of cancer, triple-negative tumors do not have targeted agents that can be used in the early setting. With ongoing research trials and new treatments, TNBC is becoming a treatable breast cancer with increased survival rates, giving hope to patients with this diagnosis.

Dietary Amelioration Of Inflammation Associated With Breast Cancer

Breast Cancer Vaccine Trial to Prevent Recurrence of Triple Negative ...

Many studies suggest that low-grade inflammation is mitigated by healthy dietary habits, such as polyphenols and the Mediterranean food pattern, resulting in lower circulating concentrations of inflammatory markers . Western-type or meat-based patterns are positively associated with low-grade inflammation . Among the components of a healthy diet, whole grains, vegetables and fruits, and fish are all associated with lower inflammation, and a limited number of observational studies suggested a pro-inflammatory action of diets rich in saturated fatty acids or trans-monounsaturated fats . The association between inflammation and cancer has been reported elsewhere , citing major mediators nuclear factor kappa B , tumour necrosis factor , and cyclooxygenase-2 , given the combined role in inflammation, cell proliferation, angiogenesis, and metastasis. Inhibition of COX-2 thus blocking the inhibition cascade may be an important mechanism by which polyphenols exert benefit to the breast cancer patient. The consumption of polyphenol-rich foods is thought to have an effect in modulating low-grade inflammation .

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Treatment For Triple Negative Early Breast Cancer

Treatment for triple negative early breast cancer may involve:

As triple negative breast cancer is usually very responsive to chemotherapy, your medical oncologist will most likely develop a chemotherapy treatment plan for you. This will take into account your own individual needs and preferences.

Chemotherapy for triple negative breast cancer is often given before surgery. This is called neoadjuvant chemotherapy. There are a number of benefits in having chemotherapy before surgery.

  • You can see if the chemotherapy is working .
  • You may be able to have breast conserving surgery instead of mastectomy if the tumour shrinks enough.
  • It gives you time to have genetic testing done to determine if you have an inherited gene mutation if the test comes back positive it may affect your decision around what type of surgery to have.

Treatment for triple negative breast cancer may also include radiotherapy after surgery, especially if you have breast conserving surgery.

You may be offered immunotherapy treatment through a clinical trial, although there are strict eligibility criteria. You can talk to your medical oncologist about any clinical trials that may be suitable for you.

Get Regular Tests For Breast Cancer Recurrence

One last step is to periodically utilize key testing mechanisms to make sure your cancer-free goals are on track.

The first test is the C Reactive Protein inflammatory marker test, which can be done easily through your primary physician. High CRP levels are a known indicator of higher cancer risk. A 2009 Danish study on over 10,000 people found that CRP is directly connected with early death after a cancer diagnosis. A 2018 Korean investigation found that inflammation can stimulate the production of Breast Cancer stem cells.

Another test I recommend is the RGCC Oncotrail for Breast Cancer. The Oncotrail is a personalized test that looks at your circulating tumor cells as well as your breast cancer stem cell count. It will also tell you which natural substances would help your body the most.

Finally, dont discount breast self-exam for recurrence prevention as well. A 23-year long study conducted at the University of Washington found that while risky mammography found lumps 43% percent of the time, human touch found them 56% of the time. I recommend regular breast self-exam at any stage of your healthy breast journey. Click HERE to learn more.

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Disease Characteristics And Biomarkers

A reduction in breast cancer incidence and mortality is the gold standard criteria for success in a clinical trial however, this approach is expensive and ethically difficult to implement. The use of surrogate breast cancer biomarkers is an appealing alternative. Breast cancer biomarkers useful for investigating the efficacy of polyphenols include specific oncogenic pathways , levels of circulating disease related proteins, such as ostrodial or estrogen, changes in breast cancer histology and cytology, genomic alterations

A major challenge in the treatment of breast cancer is its high heterogeneity from patient to patient, which initiated its classification into three major molecular subtypesestrogen receptors , progesterone receptors , and HER2, hormone receptor positive with luminal A and luminal B phenotypes, HER2 positive , and triple negative/basal-like . About 70% of breast cancers are estrogen receptor positive . Recent data suggest that molecular subtypes differ substantially in the intracellular pathways responsible for cell growth and metastatic spread, suggesting a wide array of potential molecular targets of polyphenols . The efficacy of polyphenolic therapy is likely to differ pending the breast cancer stage and subtype.

Breast Cancer Recurrence And What You Can Do To Prevent It

Ask the expert: Triple-negative breast cancer with Rita Nanda, MD

I never imagined it would happen again.discovering that suspicious lump and facing another healing journey. But once I got over the initial shock and disappointment and got centered, I innately knew why I was dealing with breast cancer for a second time.

A recurrence of breast cancer is a fear that lingers in the background for many women who have been diagnosed. But once you understand the mechanisms and reasons for the recurrence, there need not be any fear, because you can stop it in its tracks.

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Neoadjuvant Ct Versus Adjuvant Ct

Compared with adjuvant CT, neoadjuvant CT led to no significant improvement in OS or DFS in patients with TNBC. However, when PCR was achieved after NACT, the OS and DFS were significantly improved. The OS was lower when there were residual lesions after neoadjuvant therapy .12

Compared with patients with non TNBC, patients with TNBC had higher PCR rates after NACT , and DFS and OS were significantly improved in patients with PCR. The PCR rate in patients with TNBC with high Ki-67 expression was higher than that in patients with low Ki-67 expression .13

Where Does Breast Cancer Usually Recur

Regional recurrence means the cancer came back in the lymph nodes in the armpit or collarbone area near where the original cancer was diagnosed, or in the chest wall or skin of the breast. A regional recurrence is considered locally-advanced breast cancer and is usually considered stage III breast cancer.

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What Is The Treatment For Triple Negative Breast Cancer

Healthcare providers and researchers are making significant progress on TNBC treatments. Recent clinical trials are testing new combinations of drugs and new approaches to existing treatments. Some existing treatments are:

  • Chemotherapy: Providers might combine chemotherapy and surgery, with chemotherapy being used to shrink your tumor before surgery or after surgery to kill cancer cells throughout your body.
  • Surgery: This could be a lumpectomy to remove an individual lump, or a mastectomy to remove an entire breast. Providers then perform a sentinel node biopsy or axillary node surgery to look for signs your breast cancer has spread to your lymph nodes.
  • Radiation therapy: Post-surgery radiation therapy helps reduce the chances your cancer will return or recur.
  • Immunotherapy: This treatment stimulates your immune system to produce more cancer-fighting cells or help healthy cells identify and attack cancer cells. Immunotherapy can be added to chemotherapy to before surgery to shrink the tumor. You might also receive immunotherapy for about a year after your surgery and post-surgery radiation therapy.


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