Posts tagged with 'recurrence'

BRCA Genes and Cancer

  • Posted on September 1, 2010 at 9:48 pm

Mutations in the BRCA1 or BRCA2 gene predispose people to breast cancer and ovarian cancer as well as prostate cancer (BRCA1) and other cancers (BRCA2).  In families passing down an inherited genetic mutation, multiple family members get the same type of cancer.  About 5 to 10 percent of breast cancers are hereditary.

At my last checkup in May 2010 my new oncologist suggested I be tested for genetic variations in BRCA-1 and BRCA-2. Even though I have no family history of breast cancer, his recommendations were based on my diagnosis at the relatively young age of 43 and my recurrence at age 52. The test results would gift my sons with knowing of any inherited increased risk of contracting cancer. In addition, I would discover if my risk for ovarian cancer was higher than it otherwise would be.

This test is neither cheap nor without controversy.  Even with insurance kicking in, I paid $375 out of my own pocket to obtain the results. And having worked as a patent attorney for over 32 years, I know that the cost heavily correlates with the BRCA-1/-2 patents held by Myriad Genetics, which conducts the tests. In late March of this year, a federal judge invalidated Myriad’s seven patents on these two genes. The decision, if upheld, could throw into doubt patents covering thousands of human genes and reshape the law of intellectual property. I realize the cost of the test is high, but also understand that patents are a limited monopoly granted by the U.S. Constitution and thus to be taken seriously. In the medical field where expense-shaving is lauded, patents often conflict with cost-cutting measures for prescription drugs and medical tests.  I’ll leave this debate to the intellectual property gurus for now.

Rising above the politics and blessed to be able to afford it, I opted for the test. Just yesterday I discovered I don’t have mutations in these two genes.  Joy fills my heart at this news. Not least because I don’t have to be screened so carefully for ovarian cancer. The biggest reward, though, is that my sons don’t have this added burden of genetics to ponder as they age. Life is hard enough without being concerned that a cancer gene or two might raise its ugly head when least expected.

Undergoing this test, however, has increased my compassion for those people found to have BRCA mutations.  Many support groups are tailored to this patient population. Most organizations such as FORCE and BrightPink are national with affiliate branches all over the U.S.  Patients or family members may want to start a branch in their own community. They can ask genetic counselors for specific support groups in their area. Their local hospital, Breast/Ovarian Cancer center, or doctor’s office may have information on local support groups. In addition, online support groups exist. Check out, for example, http://www.inspire.com/groups/advanced-breast-cancer/discussion/brca1-and-or-triple-negative, http://inthefamily.kartemquin.com/content/i-have-brca-mutation#support, and http://www.experienceproject.com/groups/Am-Brca1-Positive/184620.  My prayers go out to these precious folks – and may they never lose hope or the comfort that God can bring.

For more information on BRCA-1 and -2 testing, I recommend the following respected links: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA and http://www.mskcc.org/mskcc/html/8623.cfm.

Colorful and snappy September days to you.

Blessings,

Jan

Breast cancer drug not considered cost-effective in U.K.

  • Posted on June 12, 2010 at 6:44 pm

A U.K. national health institute concluded last week that Tykerb, a new breast cancer drug that helps women with advanced breast cancer survive longer, is not cost-effective.  This decision means that about 2,000 patients in the U.K. will no longer receive the drug. My oncologist told me someone moved to my area from London to get Herceptin, another drug that is effective against breast cancer. She was not able to get it in England.

Tykerb is being tested along with Herceptin as a possible treatment for early-stage breast cancer. If it is found effective, I’m praying that the U.K watchdog institute will cover it, since early-stage intervention should be considered more cost-effective.

I’m saddened by this news, but not surprised, given the British cost-strapped government’s need to cut somewhere. Read more at http://www.huffingtonpost.com/2010/06/10/uk-recommends-against-buy_n_607392.html.

Meanwhile, I’m encouraged by the fact that over 10 million cancer survivors live in the U.S.  I discovered this fact at my local Relay for Life last week. We are surviving longer and longer.

June blessings to you.

Jan

Opting for breast reconstruction

  • Posted on May 15, 2010 at 4:33 pm

Exciting breast cancer news is blossoming as fast as May flowers.  It’s hard to choose a topic upon which to post. I decided to pick the recent study on the popularity of breast reconstruction.

One in three.  I was surprised by this number of women eligible for breast implant reconstruction surgery who opted for the procedure, at least in four California counties. This number is not representative of the U.S. according to doctors who responded to this study.  But it got attention from the medical community. The results showed that  older women, non-white women, women without insurance, and women not treated at a teaching facility where a plastic surgeon is more likely to be on hand are less likely to opt for reconstruction.

Limited to implants, the study did not address how many women decided to undergo flap reconstruction (using tissue from their own body) after mastectomy.  Flap reconstruction has some real advantages, but also some additional risks as compared to implant surgery. I was not eligible for an implant on my radiated side, so my reconstruction would have consisted of an implant on one side and flap reconstruction on the other. Not a pretty prospect. Especially when the implant doesn’t last as long as the flap breast mound.

Hence, I’m among those who rejected reconstruction after a bilateral mastectomy: a white women of 51 (at the time I was treated) in a rural area who had good insurance.

What to conclude?  I wish no one had to make this choice. Reconstruction is a highly personal–and wrenching–decision involving factors such as medical history, tolerance of risks, and marital and cultural as well as financial considerations. Prayer is key to getting through it. I know. I’ve been there.

Read more at http://www.webmd.com/breast-cancer/news/20100430/why-some-breast-cancer-patients-forgo-implants.

Blessings,

Jan

Another possible culprit in breast cancer’s spread

  • Posted on April 17, 2010 at 1:08 pm

I’m excited about another avenue researchers are exploring to understand how breast cancer cells metastasize: the role of lincRNAs in turning off tumor suppressor genes. Published in the latest issue of Nature magazine, the finding may lead to a test for predicting metastasis as well as drugs for preventing it. Read more about it at: http://blogs.monografias.com/sistema-limbico-neurociencias/2010/04/16/are-lincrnas-the-new-culprit-in-cancers-spread/.

While still in its infancy, this research, as noted by molecular geneticist Maarten van Lohuizen of the Netherlands Cancer Institute in Amsterdam, is “important and provocative.”  At the same time Dr. van Lohuizen notes that the finding raises many questions.

As a breast cancer survivor of many years I applaud this new molecular approach to the difficult question of how cancer cells spread throughout the body. Any new insight into this field can only help patients.

Peace and hope,

Jan

Multivitamins and Breast Cancer

  • Posted on April 11, 2010 at 4:24 pm

What do we make of the latest study suggesting that taking a daily multivitamin might increase a person’s risk of developing breast cancer?

If you haven’t heard about this study, a Swedish government agency found recently that women who took multivitamins were 19 percent more likely to develop breast cancer.  When they started the study, none of these women had had breast cancer. See the news at:  http://www.rttnews.com/ArticleView.aspx?Id=1260274. The researchers have not yet identified what ingredient(s) in the multivitamin capsule might be responsible for this observed effect.

Before you dispose of all your multivitamins, do a reality check.  If you have been following health news for any period of time, you realize the landmines of taking seriously all these studies. Some health research findings have proven true as a trend over the years, but others have been contradicted or disproved. I believe it’s important to know which brand and type of multivitamin was tested. At my local drugstore I recently found myself overwhelmed by the number of choices of multivitamin available to the consumer. And a stop at any health food store would only amplify those choices.

What’s a health-conscious person to do?

I plan to ask my new oncologist next month if taking my particular brand of multivitamin is a plus or a minus in my risk for a second recurrence of breast cancer.  Only if he confirms the findings will I throw out my pills the way I threw out my tampons two months into my first chemo.  If you are at all concerned about these findings, I suggest you do the same: check with your primary physician or oncologist to determine whether your multivitamin supplement is still right for you.

Happy April!

Jan

Could baby aspirin be a cure-all for breast cancer survivors?

  • Posted on February 22, 2010 at 9:01 pm

You may have seen the latest results of a long-term Nurses’ Health Study showing that low doses of aspirin may prevent a breast cancer recurrence. Specifically, the study found that women who took aspirin two to five days a week had a 60 percent reduced risk of their cancer spreading and a 71 percent lower risk of breast cancer death. Taking aspirin less frequently than two days or more frequently than five days was not as beneficial in reducing risk of cancer spread or death.  Most of these women were taking low-dose aspirin to prevent heart attacks and stroke. While the dosage wasn’t tracked, most likely it was 81mg, the typical low maintenance dose for maintaining heart health, equal to one baby aspirin.

This is an exciting development worth exploring!

If you are a breast cancer survivor, you should consult your oncologist before beginning baby aspirin therapy. One commentator, PJ Hamel, suggests the following (http://www.healthcentral.com/breast-cancer/c/78/104011/recurrence?ic=6006):

•If you’re in active treatment (surgery, chemo, radiation), don’t self-medicate with aspirin; it can interfere with your other treatments.
•If you’re on long-term hormone therapy or past all cancer treatment, ask your doctor about the risks and benefits of aspirin in general.
•If your doctor feels you’re at minimal risk for adverse side effects from aspirin and you understand those risks yourself, and accept them – then you might consider a low dose.

I believe this is sound advice. At my primary doctor’s urging I have been taking baby aspirin seven days a week for the past two years to maintain a healthy heart. Perhaps I shall cut down to weekday doses, since the study suggests that 2-5 days of treatment is optimal. This reassuring news is timely to me, because I go off my aromatase inhibitor (Arimidex) in a week.

A report on this study can be found at:  http://www.reuters.com/article/idUSTRE61F56Q20100216.

Blessings to you all!

Jan

Breast cancer recurrence from moderate alcohol intake

  • Posted on December 20, 2009 at 5:56 pm

Red wine has an aspirin-like effect, reducing the blood’s ability to clot, and also contains antioxidants. It’s great for the heart, but what about breast cancer? Perhaps the jury is finally in on this issue.

The latest study of breast cancer survivors who consume alcohol was reported in San Antonio, TX this month (http://www.medpagetoday.com/MeetingCoverage/SABCS/17444). Funded by the National Cancer Institute, the eight-year research project showed that early-stage breast cancer survivors who drank an average of at least three to four alcoholic beverages per week had a 34 percent higher risk of recurrence than those who drank less than one drink per week or no alcohol.  (One drink is defined as a 5-ounce glass of wine, a 12-ounce glass of beer, or a 1.5-ounce shot of liquor.)  This risk was even higher for those who were post-menopausal, overweight or obese.

Per WEEK, not per day? So much for enjoying the entire Mediterranean diet guilt-free.

Precisely how alcohol consumption influences breast cancer risk is not fully understood, says the lead researcher on the study, Marilyn L. Kwan, Ph.D., a staff scientist at Kaiser Permanente in Oakland, CA.  But estrogen, which fuels the growth of most types of breast cancer, is likely a culprit. “It has been suggested that alcohol could increase the risk of breast cancer by increasing estrogen metabolism and circulating levels of estrogen, thus promoting growth of the tumor,” says Dr. Kwan. “A similar mechanism might be responsible for increasing the risk of breast cancer recurrence.”

As a lymphedema patient-advocate I know Dr. Kwan and have great respect for her work. I plan to take her research seriously.

During the seven years between my first diagnosis and my recurrence, I might have averaged at least three drinks of wine a week.  I’m post-menopausal, although not overweight. And I will be going off Arimidex (which reduces estrogen levels in the body) in early March. Therefore, I will call my oncologist to determine what these results mean for me. It appears from the study that two drinks a week did not increase the risk of recurrence, but is that okay for me personally?

Like Dr. Kwan, I encourage early-stage breast cancer survivors or their caregivers to consult their medical professionals to assess personal risk. Breast cancer is such a diverse disease, and red wine in small-to-moderate amounts might benefit those with a personal or family history of heart disease.

My poor oncologist. Is he prepared for my next question-of-the-week about lifestyle choices? But I am compelled to ask. A second recurrence is not one of my New Year’s resolutions! And non-alcoholic drinks can be pretty tasty. Just ask my non-imbibing Christian friends, who engage wine-drinking Christians in constant debates about the biblical propriety of consuming alcohol.

Here’s a Martinelli’s toast to your health for the New Year, and a very Merry Christmas.

Jan

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