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Phew! End of the month. It’s been fun. I hope I was helpful and informative. At minimum, I hope I increased awareness.
For my last post, I simply want to say that everyone should keep their eyes open for new developments in medicine and in particular, cancer, as we are making progress daily.
Stay aware of your body and how it feels and changes over time. Stay active. If you had a problem with your vision, you’d seek help. Same should go for your breasts or other body parts. People go for eye exams annually, think of that when you are due for a mammogram.
Plan your mammogram around your birthday so you don’t forget! Many wish for good health when blowing out the candles- annual mammograms increase those chances.
Now on to Movember ….
The home stretch. The penultimate day… Early morning meeting got me thinking of how the month started. On Day #2 I showed a pic of me and Dr. Allison, the “inventor” of immunotherapy who won the Nobel Prize of Medicine this year for his work.
What is immunotherapy?
Immunotherapy is not chemotherapy. It is a treatment that we are now using for cancers that takes advantage of the patient’s own immune system to fight off cancer cells. Cancer had figured out a way to hide from your body’s protective mechanism, the immune system. When people get an infection, it is their immune system that fights off the bacteria or virus and allows us to get well and not get sicker from that infection. Unfortunately, cancer figured out a way to hide from our immune responses.
When immunotherapy is used in cancer treatment, it is an attempt to stimulate our immune system to destroy cancer cells and tumors. One of the earliest forms of immunotherapy is BCG vaccine, which was originally to vaccinate against Tuberculosis, but later found to be very useful in the treatment of bladder cancers (another specialty of mine). Nowadays, immunotherapies are used for many different kinds of cancers, including bladder, and in some diseases can potentially cure (yes, we think cure!) patients. Jimmy Carter’s metastatic melanoma treated with immunotherapy a few years ago is a great example of this advancement in my field!
Some immunotherapies are either “releasing the brakes” on the immune system and allowing it to attack cancer. Some immunotherapies “step on the gas” and activate the immune system so that it destroys cancer. One of the most interesting technologies to be developed is something called “T-cell adoptive transfer” otherwise known as “CAR T therapy” (chimeric antigen receptor T-cell therapy).
In CART therapy, T-cells (which are immune cells) are removed from a patient’s blood and a gene that is responsible for programming the cell to recognize a specific marker on a cancer cell is then inserted in the T-cell. The newly modified T-cell with these “CARs” are further harvested and grown and then infused back into the patient. Once reintroduced to the patient, they grow, multiply, and become a “normal” part of the patients immune system and start fighting cancer! They can stay with the patient life-long! Two CART therapies have been approved thus far for lymphomas in a setting where patients would have otherwise been placed on hospice to die, but rather some will be cured! This technology is now being tested for other cancers such as lung cancer, GI cancers and others.
To bring this back to breast cancer, just this past week, another type of immunotherapy called a PD-L1 inhibitor was presented at an international meeting (ESMO) which showed incredibly promising results in metastatic triple negative breast cancer, a disease that is difficult to treat (see mid-month’s post on Day 16) when it was combined with chemotherapy!
We are now testing immunotherapies in earlier stages of cancer, as we think of vaccinations in our lives. If we can teach our immune system to fight off diseases such as measles, mumps, rubella, small pox, tetanus, etc, why can’t we do the same for cancers?
The sign above my head that is lit up in the darkness of early morning is a place where we are using immunotherapies in clinics and have helped develop these agents through our participation in clinical trials.
It is an incredible time to be an oncologist, as we are getting closer to a cure. I hope within my career, I am able to bring that reality to every patient I meet.
At the gym, I watched the news and EVERY commercial was political. I figured we can review costs of healthcare and why votes count!
Did you know that it costs $140,000 to care for an uninsured patient compared to ~$10,000 for someone with insurance? Only 54% of uninsured women over 40 have had mammograms compared to 78% of insured women. In terms of survival, 5 year overall survival is only 80% if you are uninsured, and it jumps to 92.7% for those with coverage.
Sad, but true. Access for all makes sense.
This is exactly why my institution has free screening programs and coverage for all women, as does other hospitals and organizations. Lack of insurance should not be an excuse not to get yourself checked, or to have worse outcomes. Get out and vote!
As I celebrated the Pink and Teal brunch today in Cherry Hill, NJ, with some of the leadership at MD Anderson Cancer Center at Cooper, I was wondering where did National Breast Cancer Awareness Month (NBCAM) come from?
NBCAM was founded in 1985 in October as a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries (now part of AstraZeneca, producer of several anti-breast cancer drugs). The aim of the NBCAM from the start has been to promote mammography as the most effective weapon in the fight against breast cancer.
In 1993 Evelyn Lauder Senior Corporate Vice President of the Estée Lauder Companies founded The Breast Cancer Research Foundation and established the pink ribbon as its symbol, though this was not the first time the ribbon was used to symbolize breast cancer: A 68-year-old California woman named Charlotte Haley, whose sister, daughter, and granddaughter had breast cancer, had distributed peach-color ribbons to call attention to what she perceived as inadequate funding for research. In the fall of 1991, the Susan G. Komen Foundation had handed out pink ribbons to participants in its New York City race for breast cancer survivors. This is where the pink ribbon that we wear started! We can now see many companies, including the NFL sporting the pink ribbon (see previous post from day #24). Even my kids are wearing pink socks for their organized sports on Saturdays and Sundays!
This awareness has helped many women and serves as a reminder to obtain their mammograms in addition to raising monies to fund breast cancer and other cancer research!
It’s Saturday. Here’s where I keep it short and sweet. (Like my strawberry cream cheese bagel that looks pink). We can dispel a couple of myths again!
- No, opening the cancer to air does not cause it to spread. (see day #13)
- No, carrying your cellphone/mobile device in your bra will not cause breast cancer.
- No, deodorant does not cause breast cancer.
- No, the radiation from mammograms do not cause breast cancer. They actually save lives!
- No, we are not hiding the cure of cancer from the general public.
- No, everyone’s breast cancer is NOT the same.
- Truth: You should get to know your breasts.
- Truth: Go for your mammograms.
- Truth: I look forward to Oct 31st.
Today is my administrative day, and I catch up on reading my journals for the week. Each week in medicine, there are publications about progress being made through clinical research. Earlier in the month I talked about research and how more patients need to participate.
Here are the titles and conclusions of some manuscripts in just two of our major journals… What’s notable is how many trials get reported each week, and these are the ones only pertaining to breast cancer (and a bonus ovary manuscript because it was cool enough to include today)! Please note, I didn’t include the many others highlighting the progress we are making in all cancers! And yes, people who have careers in healthcare (ie physicians, nurses, social workers, nutritionists, etc, etc) are required to maintain their education and remain current so that we can help others!
In New England Journal of Medicine…
Overall Survival with Palbociclib and Fulvestrant in Advanced Breast Cancer: Among patients with hormone-receptor–positive, HER2-negative advanced breast cancer who had sensitivity to previous endocrine therapy, treatment with palbociclib–fulvestrant resulted in longer overall survival than treatment with placebo–fulvestrant.
Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer: Atezolizumab plus nab-paclitaxel prolonged progression-free survival among patients with metastatic triple-negative breast cancer in both the intention-to-treat population and the PD-L1–positive subgroup.
(Bonus): Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer: The use of maintenance therapy with olaparib provided a substantial benefit with regard to progression-free survival among women with newly diagnosed advanced ovarian cancer and a BRCA1/2 mutation, with a 70% lower risk of disease progression or death with olaparib than with placebo.
And in the Journal of Clinical Oncology…
Multicenter Phase II Study of Lurbinectedin in BRCA-Mutated and Unselected Metastatic Advanced Breast Cancer and Biomarker Assessment Substudy: Lurbinectedin showed noteworthy activity in patients with BRCA ½ mutations. Response and survival was notable in those with BRCA2 mutations. Additional clinical development in this subset of patients with metastatic breast cancer is warranted.
Paclitaxel With Inhibitor of Apoptosis Antagonist, LCL161, for Localized Triple-Negative Breast Cancer, Prospectively Stratified by Gene Signature in a Biomarker-Driven Neoadjuvant Trial: This neoadjuvant trial provides evidence supporting a biomarker-driven targeted therapy approach for selected patients with GS-positive TNBC and demonstrates the utility of a neoadjuvant trial for biomarker validation and drug development…
First-Line Trastuzumab Plus an Aromatase Inhibitor, With or Without Pertuzumab, in Human Epidermal Growth Factor Receptor 2–Positive and Hormone Receptor–Positive Metastatic or Locally Advanced Breast Cancer (PERTAIN): A Randomized, Open-Label Phase II Trial: PERTAIN met its primary PFS end point. Pertuzumab plus trastuzumab and an AI is effective for the treatment of HER2-positive MBC/LABC. The safety profile was consistent with previous trials of pertuzumab plus trastuzumab. [BTW, “PFS” means progression free survival which is the amount of time patients did not have progressive cancer on the drug- the longer it is the better!]
When I was putting my shoes on today, I never know what I would be walking into in clinic… I saw someone today who had “inflammatory” breast cancer.
Inflammatory breast cancer is a rare type of breast cancer that develops rapidly, making the affected breast red, swollen and tender and occurs when cancer cells block the lymphatic vessels in skin covering the breast, causing the characteristic red, swollen appearance of the breast.
It is considered a locally advanced cancer — meaning it has spread from its point of origin to nearby tissue and possibly to nearby lymph nodes. It can easily be confused with a breast infection, which is much more common. Many times, women are initially treated with antibiotics, and if symptoms respond to antibiotics, then additional testing isn’t necessary. If the redness does not improve, or signs and symptoms persist, please seek medical attention.
At MD Anderson Cancer Center at Cooper, we have developed an Inflammatory Breast Cancer Clinic specifically for these patients, where we work quickly to obtain the diagnosis, and provide multidisciplinary care!
I decided to give you silly random facts about breast cancer today! Does my pin make me look manly?
Did you know that lifelong nuns, women who never have children, are at an increased risk of getting and dying from breast, ovarian and uterine cancers, compared with mothers. A woman’s risk of getting these cancers increases with the number of menstrual cycles she experiences. Given nuns never have children, they are at higher risk than the general population.
It is not only humans who suffer from breast cancer, some animals do too. Believe it or not, it is more common in dogs than cats, but tends to be more aggressive in cats.
The first record of a breast mastectomy was in A.D. 548 on Theodora, Empress of Byzantine.
On average, every 2 minutes, a woman is diagnosed with breast cancer.
Believe it or not, the left breast is 5 – 10% more likely to develop cancer than the right breast. The left side of the body is also roughly 5% more prone to melanoma (a type of skin cancer). Nobody is exactly sure why the left breast is more susceptible, but it has been hypothesized that the left sided melanomas might be related to driving and sun exposure on that side, because it is the opposite in England where the right side gets more sun-exposure from driving!
We have been talking about breast cancer so often, I figured I should frame it relative to other disease…
For most women, no disease seems more prevalent or scarier than breast cancer. However, heart disease is actually the number one killer of women in the United States. It kills more women aged 65 years or older more than EVERY TYPE OF CANCER combined! Women are four to six more times more likely to die of heart disease than from breast cancer. In fact, lung cancer kills many more women every year compared to breast cancer. It is a reminder that living an overall healthy lifestyle such as not smoking will decrease your risk of not only breast cancer (as discussed in Day #7), but of heart disease as well!
Also, about 19 women die every day in the US as a result from drug overdose involving prescription opioids. In fact, women are much more likely to have chronic pain syndromes and get a painkiller prescription from care providers compared to men.
Someone asked me today if it was normal to have an inverted nipple. I figured we can talk about nipples.
An inverted nipple can be a normal occurrence caused by adhesions at the base of the nipple that bind the skin to the underlying breast tissue. It’s possible to have one inverted nipple and not the other, or both. Many times, women will have this for their whole lives and it should cause very little discomfort or problems, with the exception of breastfeeding. Sometimes an inverted nipple can be difficult for an infant to latch onto, but there are methods to help the nipple protrude again, such as nipple shields.
In fact, there are actually EIGHT different kinds of nipples! These are as follows: Normal, flat, puffy, short, long, inverted grade 1, inverted grade 2, and inverted grade 3. Up to 35% of women have nipples that don’t protrude well, meaning that ‘abnormal’ nipples are actually a pretty common occurrence. Furthermore, people can have a third nipple, which can also be referred to as an accessory nipple, which are much more common in males than females. They occur in about 1 in 18 males, but only 1 in 50 females.
A nipple that was “normal” and then becomes inverted may be a sign of breast cancer in which a tumor is pulling on the tissue and causes it to invert. This would need to be checked. If it has always been inverted, no need to worry!
Another soccer dad day! This one is short and sweet…. (and it’s windy, not my new hairstyle)
Notable women who have been diagnosed with breast cancer include “Sex and the City” star Cynthia Nixon (diagnosed in 2006 at age 40), Sheryl Crow (diagnosed in 2006 at 44), Kylie Minogue (diagnosed in 2005 at 36), Elizabeth Edwards (diagnosed in 2004 at 55), Jaclyn Smith (diagnosed in 2002 at 56), and Christina Applegate (diagnosed in 2008 at 36). Other historical figures include Mary Washington (mother of George Washington), Empress Theodora (wife of Justinian), and Anne of Austria (mother of Louis the XIV).
(Facts borrowed from factsretreiver.com)
It’s Saturday, so that means being “Soccer Dad” again! I thought I was getting a little cold, so I took some vitamin C which got me thinking about alternative medications…
I have a lot of patients trying these approaches, and in fact, almost 70% of cancer patients (and the largest proportion being breast cancer patients) try “non-traditional” or complementary approaches. It makes sense as they want to do something for themselves to help themself, but in some cases, it can interfere with our treatments. Examples include curcumin interacting with taxanes, or folic acid neutralizing the effects of 5-FU or capeciatabine.
The most common fallacies that I hear are the following three;
- It is “natural” and hence better for you
- It has been used for a long time and if it didn’t work people would have stopped using it a long time ago
- It worked for a friend or a neighbor or a friend of a friend…
“It’s natural”- Curare, a compound extracted from nature will paralyze you. Certain mushrooms will kill people who try to eat them St Johns Wort interpreted with our targeted drugs and adds toxicity. Roadkill is natural, but probably not good for you.
“Old is good”- Life expectancy has never been higher. This is from advanced in medicines and improving our “older” treatments. If old is so good, we would still be drilling holes in people’s head to relieve headaches or bleeding people for fevers and infections. I’d personally prefer some ibuprofen and antibiotics.
“It worked for someone else”- Other than an anecdotal response, those are typically related to something else like conventional treatment in addition to whatever. Furthermore, I see many patients confuse benign disease with cancer, and hence a “miracle cure.” The testimonies are actually marketing. Oftentimes the so-called “alternative medicines” that does virtually nothing are the ones that lasts longest in the market because if it doesn’t harm anyone, there is a tendency not to study it by medical experts. So it continues to sell and the manufacturers can claim anything they like.
I can list tons and tons of alternative treatments, but the list would be too long and I would miss a bunch. It’s a multi billion dollar industry. High dose vitamin C has not only killed patients of mine when they chose to take a non-evidence based treatment approach, but it also financially destroyed their families they left behind. Alkalinizing your body is silly. You can’t. Your lungs and kidneys keep your blood as close to 7.4pH as can be. You’re just alkalinizing your urine, making more expensive urine and breathing a little slower.
Last point: if you want to do something for yourself, eat healthy and move more. Rather than take extra supplements, get those compounds through your diet. You will be eating healthy (imagine exchanging a red meat for a fish serving to get more omega-3‘s and fish oil)! If you want to try some of these products, use them as a complement to traditional Western evidence-based medicine, not as an alternative. And please be sure to tell us you are taking them! There are some accepted therapies, such as acupuncture. Please include your docs in these conversations!
Score is 2-0. We are losing. At least Leyna is having fun!
Day 19: This morning at GU tumor board. We were discussing a prostate cancer case when I took this selfie. BTW, early happy birthday wish to the other man in pink: Christian Squillante (and hi Sue Gnibus Wasienko, happy birthday to your 21 year old daughter!). Hi Keithe Saclayan Shensky, our awesome fellow!
Yes, not breast cancer, but lots of similarities such as being the most common cancer for men (just like breast is for women), treated with hormonal therapies, and millions of survivors!
Other than skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Society’s estimates for prostate cancer in the United States for 2018 are: About 164,690 new cases of prostate cancer, with about 29,430 deaths from prostate cancer, so most will do well!
1 in 9 men will be diagnosed with prostate cancer during his lifetime. (Used to be 1 of 6, but we stopped looking so carefully.)
Prostate cancer develops mainly in older men and in African-American men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66.
PSA screening is a blood test that might indicate cancer, though is very non-specific and can simply indicate benign overgrowth, infection/inflammation, trauma or other causes. Nevertheless, it is a useful test for men, and even if you are diagnosed with prostate cancer, the majority of the men diagnosed may simply be watched withOUT treatment- called “active surveillance.”
So men, please get checked!
Not all women have a one-in-eight risk for breast cancer: This often-cited statistic is somewhat misleading.
Breast cancer risk varies based on a variety of factors, including age, weight, and ethnic background. Risk increases as you get older (http://www.cdc.gov/cancer/breast/statistics/age.htm): most breast-cancer cases are in women in their 50s and 60s. Also, some ethnic groups appear to be more susceptible to breast cancer; the National Cancer Institute in the U.S. says that white, non-Hispanic women have the highest overall risk of developing breast cancer, while women of Korean descent have the lowest risk, but African-American women have a higher death rate.
Finally, being overweight or obese may also up your risk; there is evidence that being obese or overweight after menopause can up your breast-cancer risk, possibly because fat tissue is a source of estrogen.
If you get your mammogram at Cooper’s Imaging Center, you can get a fantastic whatchamacallit! (I think it is a keychain)
I am hiding my pink today under my scrubs!
I figured out talk about the choice of surgery when confronted with breast cancer:
Many patients feel that mastectomy increases the chances of cure over lumpectomy followed by radiation.
There was a study done many years ago that prove the chance of cure regardless of your surgical choices equal. Nowadays, patients can keep their breast knowing the choice of lumpectomy followed by radiation will serve him well. Furthermore, the radiation duration has gotten shorter over the years!
Taking a step further, women who undergo treatment prior to surgery who have complete resolution of their tumor or being considered for a clinical trial that ultimately will forego surgery!! This trial is available with us at MD Anderson Cancer Center at Cooper, through our Houston colleagues.
Lastly, if the mastectomy is required for medical reasons, there are ways that women can achieve a beautiful cosmetic appearance with many different surgical and plastic surgery options.
Things we talked about in tumor board today, and here’s an action shot… “Breast Cancer phenotype.” (Ooh, by the way, this pic is HIPAA compliant!)
There are several types of breast cancer based on the biology of tumors. The subtypes respond to different treatments and have different prognoses. Breast cancers are currently classified using 3 primary markers such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). If a breast cancer does not have any of these receptors, it is considered a “triple negative” breast cancer. Because it does not have a “targetable” receptor, we cannot use endocrine therapy (“ hormone treatment”) or medications that target HER-2 such as trastuzumab, pertuzumab, TDM-1, etc as I talked about in Day #3.
If you are hormone receptor positive, we discuss giving medications like tamoxifen, or an aromatase inhibitor like anastrozole, letrozole, or exemestane. Other hormonal therapies exist as well that are injectable such as fulvestrant. Regardless, many times, we may be able to avoid more toxic therapies such as chemotherapy. In triple negative breast cancer, given we do not have the ability to use hormone receptor or HER-2 targeted therapy, we must treat the patient with chemotherapy.
It’s not a particularly sunny day today, though I figured I can talk about vitamin D.
Vitamin D helps the body absorb calcium, which is essential for good bone health. All women are on medications for breast cancer that lower estrogen levels, it is important to keep the bones healthy! Vitamin D also helps the immune, muscle, and nervous systems function properly. Most vitamin D is made when an inactive form of the nutrient is activated and her skin when it’s exposed to sunlight. As more and more people spend most of their time out of direct sunlight or wear sunscreen, and is more people eat animals that are no longer at pasture, vitamin D exposure and consumption is limited.
Research suggests that women with low levels of vitamin D have a higher risk of breast cancer. Vitamin D may also play a role in controlling normal breast tissue growth and may be able to stop breast cancer cells from growing! Ask your care provider about vitamin D.
My other best accessory with pink shoes… Got me thinking about the future…
We make progress through breast cancer research. To do know that in the United States, only 3-4% adult cancer patients go on clinical trials? To you realize that if we asked clinical trial participants if they had a good experience, the vast majority (~90%) will say yes? And did you know that getting treated at a cancer center that participates in clinical research improves the care of ALL cancer patients?
We also know that some of our highest risk patients like minority women do not have good representation in our national trials and specifically, African-American women have a higher death rate from breast cancer than Caucasian woman. We need to change that through research, education, and awareness.
Modern breast cancer clinical trials are not “experiments.” Patients are not “guinea pigs.” It is through cutting edge research that we make progress. It saves lives.
Since I have graduated from medical school a short 20 years ago, 5 year breast cancer specific survival has gone from the 70 percentile range to more than 90% through this research! I wonder what the next 20 years holds?
Even doctors have to try and be healthy! This is me at the gym trying to work off the wings I had last night. 😂
Approximately 155,000 Americans are currently living with metastatic breast cancer, which occurs when cancer in the breast spreads to other body parts (most often the bones, lungs, liver or brain). About 25% of these patients represent those whose metastatic disease was found at diagnosis, while others have experienced metastatic recurrence of early stage disease. Luckily, only a minority of patients (approximately 20%) of people first diagnosed with early stage disease will later develop advanced or metastatic cancer.
Have you ever heard the myth, “when you open up the cancer to air, it causes it to spread?” This really bugs me. People state that cutting into blood vessels will allow cancer cells to spread. This is all a fallacy. BS. Hogwash. A myth. Old wive’s tale.
In fact, surgery CURES breast cancer. Removing the cancerous tumor from the breast (or lymph nodes) is the only way (today) to stop cancer from spreading. The reason why cancers can recur and cause metastatic disease is that PRIOR to surgery, a few cancer cells- and it only takes one- could have escaped already and implanted a “seed” somewhere else in the body. The proportion of women as noted above might have it recur at a later date because it can take months to years before that “seed” called a micrometastasis rears it’s ugly head. Prior to surgery the so-called “horse left the barn.” So it appears that surgery causes it to spread because everyone who has a curable cancer typically has surgery to cure them!
Unfortunately the metastatic disease is due to the escaped tumor cells well prior to surgery.
So the next time someone who is four years shy of a medical degree says “if you open of the cancer to air you will cause it to spread,” please share with them that it is just a myth!
Here I am leaving the pinnacle of oncologic care…
Research suggests breast-feeding for a year or more slightly reduces the overall risk of breast cancer. A woman can reduce her risk of breast cancer by about 7% if she breast feeds for about 18 months. Why? One possible explanation is that breast-feeding often interrupts periods, meaning fewer menstrual cycles and less estrogen exposure. Others suggest that reduced risk can be credited to structural changes in the breast after lactation and weaning.
Exposure to environmental estrogens is also a potential risk factor for breast cancer. Environmental estrogens are a variety of chemicals and natural plant compounds that, when absorbed into the body, behave like estrogen and block the natural hormone. These includes pesticides such as the now banned DDT and PCBs. Phyto-estrogens which are estrogen-like plant compounds can also expose people to estrogens unknowingly. It appears Ben Franklin was correct when he stated “everything in moderation.”
Just finished clinic. Driving home. Decided to completely plagiarize from a friend who posted something last night (though I embellished it a little- which makes it a work that was inspired by someone, rather than simply copied like a Marvin Gay song…. lol)
Did you know that there are 4 types of breast density (how “thick” the tissues are in the breast, thus limiting how easy it is to see the parts where breast cancers typically start).
- Almost entirely fatty (easy to screen)
- Scattered fibroglandular density
- Heterogenous dense
- Extremely Dense (harder to screen)
Breast density may decrease the sensitivity of screening mammography and may prompt additional studies such as “special” mammograms, ultrasound, or MRI.
In 2005 a bill was passed mandating insurance coverage for ultrasound screening as an adjunct to mammography for women with dense breast.
In 2009, it became law to report density on mammograms in certain states. This is why you may note a “density” being reported in your mammogram report.
In fact, many screening centers now incorporate a risk tool that can tell patients if their risk of breast cancer is higher than the general population over the next five years! This could prompt further discussion with your providers!
Know your breast, and have a healthy discussion with your health providers!
I am lucky to have the best accessory with me today dressed in pink! I am counting her today as my pink item. If you look really carefully, I do have a pink ribbon pin on my scrubs, but she told me that was weak. 😂
As of January 2018, there are more than 3.1 million women with a history of breast cancer in the U.S. This includes women currently being treated and women who have finished treatment.
A woman’s risk of breast cancer nearly doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. Less than 15% of women who get breast cancer have a family member diagnosed with it. About 85% of breast cancers occur in women who have no family history of breast cancer. These occur due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations.
The most significant risk factors for breast cancer are gender (being a woman) and age (growing older). So here’s to our young generation!
Had to get to the office early for a meeting…
How early is early? Well, DCIS is a type of breast cancer that is considered a non-invasive breast cancer where the cancer cells line the milk ducts. “Ductal” pertains to the duct cells, “carcinoma” means cancer, and “in situ” refers to staying at the site. It is considered “Stage 0,” the earliest stage of a breast cancer. DCIS tends to be treated just like other kinds of breast cancer with either a lumpectomy (removing the disease from part of the breast) followed by radiation, or a mastectomy. Some cutting edge research has us simply watching DCIS, or not giving radiation after surgery. Sometimes in medicine, “less is more,” and we hope to spare women side effects of treatment.
Many times, in the case of hormone receptor positive DCIS (will discuss receptors in another post) we will give endocrine therapy (types of “hormone” treatments) for 5 years that will reduce the risk of future new breast cancer by 50%. In fact, those same medications can be given EARLIER, in patients WITHOUT breast cancer, to PREVENT breast cancer from happening!
In the case of breast cancer, earlier is better. Get your mammogram!!
Sometimes it’s not breast cancer. I saw someone today for high risk (meaning there is a elevated risk of cancer, but no cancer)…. she had a benign lump in her breast…. What are common BENIGN diseases of the breast that can mimic cancer?
- Benign (non-cancerous) breast conditions are very common, and most women have them. In fact, most breast changes are benign. Unlike breast cancers, benign breast conditions are not life-threatening. But some are linked with a higher risk of getting breast cancer later on. Some breast changes may not cause symptoms and may be found during a mammogram. But sometimes they can cause symptoms that are like those from breast cancer, so it can be hard to tell the difference from just symptoms alone. If your symptoms or mammogram results suggest that you may have a problem with your breast, your doctor will take more steps to find out what it is. Many breast lumps turn out to be caused by fibrosis and/or cysts, which are non-cancerous (benign) changes in breast tissue that happen in many women at some time in their lives. These changes are sometimes called fibrocystic changes, and used to be called fibrocystic disease. Fibrosis and/or cysts are most common in women of child-bearing age, but they can affect women of any age. They may be found in different parts of the breast and in both breasts at the same time.
- Fibrosis: Fibrosis refers to a large amount of fibrous tissue, the same tissue that ligaments and scar tissue are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch.
- Cysts: A round, movable lump, which might also be tender to the touch, suggests a cyst. Cysts are fluid-filled, round or oval sacs within the breasts. They are most often found in women in their 40s, but they can occur in women of any age. Monthly hormone changes often cause cysts to get bigger and become painful and sometimes more noticeable just before the menstrual period. Cysts begin when fluid starts to build up inside the breast glands. Microcysts (tiny, microscopic cysts) are too small to feel and are found only when tissue is looked at under a microscope. If fluid continues to build up, macrocysts (large cysts) can form. These can be felt easily and can be as large as 1 or 2 inches across.
- Adenosis of the Breast: Adenosis is a benign (non-cancerous) breast condition in which the lobules (milk-producing glands) are enlarged, and there are more glands than usual. Adenosis is often found in biopsies of women who have fibrosis or cysts in their breasts. There are many other names for this condition, including aggregate adenosis, tumoral adenosis, or adenosis tumor. Even though some of these terms contain the term tumor, adenosis is not breast cancer. Sclerosing adenosis is a special type of adenosis in which the enlarged lobules are distorted by scar-like tissue. This type may cause breast pain.
- Fibroadenomas of the Breast: Fibroadenomas are common benign (non-cancerous) breast tumors made up of both glandular tissue and stromal (connective) tissue. Fibroadenomas are most common in women in their 20s and 30s, but they can be found in women of any age. They tend to shrink after a woman goes through menopause. Fibroadenomas can often feel like a marble within the breast. Some fibroadenomas are too small to be felt, but some are several inches across. Fibroadenomas tend to be round and have clear-cut borders. You can move them under the skin and they’re usually firm or rubbery, but not tender. A woman can have one or many fibroadenomas.
- Intraductal Papillomas of the Breast: Intraductal papillomas are benign (non-cancerous), wart-like tumors that grow within the milk ducts of the breast. They are made up of gland tissue along with fibrous tissue and blood vessels (called fibrovascular tissue). Solitary papillomas (solitary intraductal papillomas) are single tumors that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast. They may be felt as a small lump behind or next to the nipple. Sometimes they cause pain. Papillomas may also be found in small ducts in areas of the breast farther from the nipple. In this case, there are often several growths (multiple papillomas). These are less likely to cause nipple discharge. In papillomatosis, there are very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are.
- Fat Necrosis and Oil Cysts in the Breast: Fat necrosis is a benign (non-cancerous) breast condition that happens when an area of the fatty breast tissue is damaged, usually as a result of injury to the breast. It can also happen after breast surgery or radiation treatment. Fat necrosis is more common in women with very large breasts. As the body repairs the damaged breast tissue, it’s usually replaced by firm scar tissue. But some fat cells may respond differently to injury. Instead of forming scar tissue, the fat cells die and release their contents. This forms a sac-like collection of greasy fluid called an oil cyst.
- Mastitis: Mastitis is inflammation (swelling) in the breast, which is usually caused by an infection. It most commonly affects women who are breastfeeding, but can affect other women as well. A clogged milk duct, not fully draining milk from the breast, or breaks in the skin of the nipple can lead to infection. This causes the body’s white blood cells to release substances to fight the infection, which can lead to swelling and increased blood flow. The infected part of the breast may become swollen, painful, red, and warm to the touch. The woman may also have fever and a headache, or general flu-like symptoms.
- Duct Ectasia: Duct ectasia, also known as mammary duct ectasia or periductal mastitis, is a benign (non-cancerous) breast condition that occurs when a milk duct in the breast widens and its walls thicken. This can cause the duct to become blocked and lead to fluid build-up. It’s more common in women who are getting close to menopause. But it can happen after menopause, too. These are some of the less common types of benign (non-cancerous) tumors and conditions that can be found in the breast.
- Radial scars: Radial scars are also called complex sclerosing lesions. They’re most often found when a breast biopsy is done for some other purpose. Sometimes radial scars distort the normal breast tissue. Radial scars are not really scars, but they look like scars when seen under a microscope. They do not usually cause symptoms, but they are important for 2 reasons: If they are large enough, they may look like cancer on a mammogram, or even on a biopsy. They seem to be linked to a slight increase in the woman’s risk of developing breast cancer. Women who have them may be advised to see their health care provider more often than usual so tests can be done to watch for changes in the radial scars. Some providers recommend surgery to remove radial scars.
- Other benign lumps or tumors that may be found in the breast include:
- Lipoma: a fatty tumor that can appear almost anywhere in the body, including the breast. It is usually not tender.
- Hamartoma: a smooth, painless lump formed by the overgrowth of mature breast cells, which may be made up of fatty, fibrous, and/or gland tissues
- Hemangioma: a rare tumor made of blood vessels
- Hematoma: a collection of blood within the breast caused by internal bleeding
- Adenomyoepithelioma: a very rare tumor formed by certain cells in the milk duct walls
- Neurofibroma: a tumor that’s an overgrowth of nerve cells
From Doc to Dad… Running around from hospital to soccer field getting my steps in got me thinking… Walk more, sit less.
Did you know that diet and exercise can reduce risks of cancer (and other diseases like heart disease and diabetes). In the “WINS” trial (Women Intervention Nutrition Study), survivors of breast cancer had >30% decreased risk of recurrence if they modified their diet and changed behaviors towards living a healthy lifestyle. That’s as much as chemotherapy can reduce risk!
So get out and exercise. It can lower risks of breast cancer and other diseases!
As I wear my cap today hoping for some sun while I’m being the best cheerleader for #7, it got me thinking about vitamin D…
Vitamin D helps the body absorb calcium, which is essential for good bone health. While women are on medications for breast cancer that lower estrogen levels, it is important to keep bones healthy! Vitamin D also helps the immune, muscle, and nervous systems function properly. Most vitamin D is made when an inactive form of the nutrient is activated in your skin when it’s exposed to sunlight. Smaller amounts of vitamin D are in fortified milk and other foods, fatty fish, and eggs. As more and more people spend most of their time out of direct sunlight or wearing sunscreen when they are in the sun, vitamin D production from sun exposure is limited.
Research suggests that women with low levels of vitamin D have a higher risk of breast cancer. Vitamin D may play a role in controlling normal breast cell growth and may be able to stop breast cancer cells from growing.
What increases risk of breast cancer? As stated yesterday, it’s rare in men, so female gender is the number one risk. Also, getting older, early menarche (early age of starting your period), late menopause, late pregnancy or no pregnancy, family history, excess alcohol, obesity, ethnicity/race, certain breast biopsy changes (if you had one), increased breast density on mammograms and other nuanced ones.
I want to focus on family history. If you are Jewish, there may be a very significant role for genetic testing. If you are not Jewish, get to know your family history. If there is a history of early-aged breast cancers, ovarian cancer, bilateral breast cancer, male breast cancer (given the rarity), melanoma, pancreas cancer, or prostate cancer, there may be a role for genetic testing to assess risk further. Taking it a step further, metastatic prostate cancer patients should have genetic testing.
And now back to work!
I wear two hats at the cancer center. One pertains to prostate cancer and other genitourinary malignancies, and the other breast cancer. As such, I was at a men’s health event tonight and it got me thinking about male breast cancer. Yes, men can get breast cancer. About one out of 100 breast cancers occur in males. They tend to occur with more advanced disease because they never think that it could happen. So men, if you have a lump in your breast, get it checked out!
Much more common than breast cancer in men is prostate cancer. It’s important to undergo screening for prostate cancer, but that discussion is for next month! In the meantime, here’s a pic of me wearing my pink with two Philadelphia sportscasters from tonight‘s event, Ray Didinger and Glen Macnow.
Feeling like Superman (under my scrubs was the pink ribbon)…. Saw a patient today that has “HER2 positive” breast cancer. We started treatment 5 years ago and she is still going strong! Therapies like trastuzumab, pertuzumab, TDM-1, and others that take advantage of cancer cells that display markers that other tissues do not (like HER2) have truly given us hope and made metastatic breast cancer a chronic illness for those patients!
We have made tremendous progress over the years. Immunotherapy is a treatment that uses a persons own immune system to fight cancer. Jim Allison from MD Anderson was named the recipient of the Nobel Prize of Medicine yesterday… I had the privilege to meet him 2 years ago. It is this type of groundbreaking research that we bring into clinic and help tens of thousands of patients. Congrats Dr. Allison!
Real Men Wear Pink… October is Breast Cancer awareness month, and I will be wearing pink everyday this month as I participate in the American Cancer Society’s RMWP campaign and celebrate all of my patients! I just saw a patient who celebrated her 8th year anniversary with metastatic disease with me!! Please get your mammograms. It could be a lifesaver. Breast cancer is the most common cancer in women. Please get yourself checked.
I will be sharing a picture of myself everyday this month wearing something pink….starting….. NOW!
Robert A Somer, MD, is the Head of the Division of Hematology/Medical Oncology, Director of Cancer Clinical Trials Program, and a Hematologist/Medical Oncologist with MD Anderson Cancer Center at Cooper. He is affiliated with the Breast Cancer Risk Assessment Program, Cancer Genetics Program, Hematology and Medical Oncology, Janet Knowles Breast Cancer Center, Prostate Cancer Center, and the Women’s Cancer Program.