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May 2019- Annual Mammogram

Happy day!! I got my annual mammogram at Jefferson- Honickman Breast Imaging Center and all is well- 7 years post-breast cancer!!! Annual mammograms helped them find it small and very fixable!!

Please schedule your annual mammogram! I have my appointment for 2020.

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World Ovarian Cancer Day- May 8 (My birthday)

Each year on May 8th, women living with ovarian cancer, their families and supporters, along with patient advocacy organizations from around the world, come together to raise awareness about ovarian cancer. World Ovarian Cancer Day (WOCD) is the one day of the year we all raise our voices in solidarity across the world in the fight against this disease.

The first World Ovarian Cancer Day took place in 2013. World Ovarian Cancer Day is an initiative of the World Ovarian Cancer Coalition.

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Why do we need World Ovarian Cancer Day?

Ovarian cancer has the lowest survival rate of all female cancers. Most women are diagnosed once the cancer has already spread, making it more difficult to treat. There are often delays in diagnosing ovarian cancer. That is because there is no early detection test, and symptoms are often confused with symptoms of other less severe illnesses, particularly gastrointestinal complaints.

Five-year ovarian cancer survival rates vary around the world, ranging from 30% to 45%. By comparison, five-year survival rates for women with breast cancer range from 80% to 90%.

Ovarian cancer is overlooked and underfunded – yet every woman in the world is at risk of developing this disease.

That is why we need World Ovarian Cancer Day!

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World Ovarian Cancer Day makes a difference

The impact of World Ovarian Cancer Day continues to increase! In 2018, the World Ovarian Cancer Day awareness campaign reached over 420,000 people, with supporters from 50 different countries and 45 different languages taking part.

Every time the World Ovarian Cancer Day awareness messages are shared – every Tweet, retweet, Facebook post, Like and Share – you are helping to spread the ovarian cancer message around the world. Your voice has power.

About WOCD

How Chronic Stress Boosts Cancer Cell Growth

How chronic stress boosts cancer cell growth

Published
Having conducted a new study in mice, researchers now have a much better understanding of how chronic (long-term, sustained) stress can accelerate the growth of cancer stem cells. They may also have found a way to prevent stress from doing its damage.
woman appearing stressed

Researchers now know how chronic stress fuels the growth of cancer.

Chronic stress, which a person has consistently over a long period of time, affects mental and emotional well-being as well as physical health.

Studies have tied chronic stress to accelerated cognitive impairment, a higher risk of heart problems, and problems with gut health.

Previous research also suggests that exposure to stress could speed up the growth of cancer through its impact on gene activity.

Now, researchers from the Dalian Medical University in China — in collaboration with colleagues from across the world — have located a key mechanism, which chronic stress triggers, that fuels the growth of cancer stem cells that tumors originate from.

More specifically, the researchers have studied this mechanism in mouse models of breast cancer.

Their findings — which they report in The Journal of Clinical Investigation — point the finger at the hormone epinephrine, but they also suggest a strategy to counteract the effects of stress mechanisms on cancer cells.

“You can kill all the cells you want in a tumor,” notes co-author Keith Kelley, from the University of Illinois at Chicago, “but if the stem cells, or mother cells, are not killed, then the tumor is going to grow and metastasize.”

“This,” he adds, “is one of the first studies to link chronic stress specifically with the growth of breast cancer stem cells.”

Stress fuels tumor growth

To see how stress would impact cancer cell growth in the rodents, the researchers put all the mice in small, restrictive enclosures for a week. Then, they split the mice into two groups.

They put one group into large, comfortable enclosures to discontinue the stress; these mice acted as the control group. The other group stayed in the small enclosures for another 30 days; these mice acted as the experimental group.

Following their initial investigation, the scientists saw not only that the stressed mice exhibited changes in behavior that were indicative of depression and anxiety, but also that they had larger cancer tumors than their peers in the control group.

Also, these tumors were growing at a faster rate, and on the whole, the stressed mice also had a greater number of cancer stem cells than the other mice. Still, at this point, it remained unclear exactly how stress contributed to the progression of cancer.

According to principal investigator Quentin Liu, from the Institute of Cancer Stem Cell at Dalian Medical University, “The direct signaling network between stress pathways and a cancer-propagating system remains almost completely unknown.”

He adds, “A better understanding of the biochemistry that causes stress to increase the growth of cancer cells could lead us toward targeted drug interventions, one of which we discovered in this work.”

Blame epinephrine, not cortisol

When they looked into how various physiological factors changed in the mice that had experienced chronic stress, the researchers closed in on a hormone called epinephrine.

The stressed mice had much higher levels of this hormone than the mice in the control group. Also, in mice from the experimental group that had received a drug that blocked ADRB2 — which is an epinephrine receptor — cancer tumors were smaller and the numbers of cancer stem cells were also lower.

“When most people think of stress,” says Kelley, “they think it’s cortisol that’s suppressing the immune system.” However, he adds, “The amazing thing is cortisol was actually lower after a month of stress.”

How does epinephrine help cancer stem cells thrive? The authors explain that when this hormone binds to ADRB2, the interaction boosts levels of lactate dehydrogenase, an enzyme that normally gives muscles an “injection” of energy in a danger situation. This allows the person to either fight the threat or run away from it.

A byproduct of this energy boost is the production of an organic compound called lactate. In the case of people with cancer, the harmful cells actually feed on this compound; it allows them to acquire more energy.

This means that if a person has chronic stress, they will have too much lactate dehydrogenase in their system. This, in turn, will activate genes related to cancer growth and allow cancer cells to thrive.

These data provide a novel pathway that explains how elevated epinephrine caused by chronic stress promotes breast cancer progression by acting directly on cancer stem cells.”

Quentin Liu

Is vitamin C the answer?

Next, the researchers validated their results by studying blood epinephrine levels in 83 people with breast cancer.

Sure enough, they found that people with high blood levels of epinephrine also had excess lactate dehydrogenase in cancer tumors — which the researchers had access to through breast cancer biopsy samples.

Also, people who had higher levels of the stress hormone were likelier to have poorer outcomes following treatment when compared with people with lower epinephrine levels.

Next, the scientists tried to see whether or not they could identify a strategy to block epinephrine’s ill effects on the system. In laboratory tests on breast cancer cell lines, they analyzed the effects of a few Food and Drug Administration (FDA)-approved drugs on lactate dehydrogenase production.

The most promising substance that the investigators settled on was actually vitamin C, which blocked actate dehydrogenase production in laboratory experiments. When the investigators tested this approach in mouse models, they obtained the same results: Stressed mice they’d injected with vitamin C experienced tumor shrinkage.

“Taken together, these findings show that vitamin C might be a novel and effective therapeutic agent for targeting cancer in patients undergoing chronic stress,” concludes Liu.

Brushes with Cancer comes to Philadelphia

We are excited to announce that the Brushes with Cancer Philly program will take place this summer in the city of love! If you are an artist or an individual who has been touched by cancer please consider applying to this transformative program. Applications are now available online and are due March 1st.

“Brushes With Cancer Provides Psycho-Social Support To Those Touched By Cancer To Improve The Quality Of Life For Cancer Patients, Their Family And Loved Ones, Through A Unique Art Experience.”

The Program: Creating Unexpected Intersections

Brushes with Cancer strategically matches artists with those touched by cancer to create unique pieces of artwork reflective of their journey. Over a period of 4 months, fifty selected pairs will connect in person, via skype, on the phone or by email. their relationships are guided and supported by Twist Out Cancer volunteers with the intention of creating a support system for both the artist and subject. the program finishes on a high note with our signature celebratory art exhibition, gala and auction where the artwork is revealed for the first time.

If you are interested in participating in future Brushes with Cancer programs as either an artist, inspiration or host committee member, please contact Jenna Benn Shersher at jenna@twistoutcancer.org.

Study Shows Value of Second Opinions for Breast Cancer Diagnosis

A study done in South Carolina strongly suggests that getting a second opinion can be very valuable for people diagnosed with breast cancer: more than 40% of the people in the study who asked for a second opinion had a change in diagnosis.

The research was published in the October 2018 issue of the Annals of Surgical Oncology. Read the abstract of “The Value of a Second Opinion for Breast Cancer Patients Referred to a National Cancer Institute (NCI)-Designated Cancer Center with a Multidisciplinary Breast Tumor Board.”

Many people diagnosed with breast cancer feel a sense of urgency about jumping right in and starting treatment immediately. In most cases, though, there’s time to do some research to make sure your diagnosis is correct and your treatment plan makes sense — and this may include getting a second opinion.

Getting a second opinion means asking another breast cancer specialist, or a team of specialists, to review all of your medical reports and test results, give an opinion about your diagnosis, and suggest treatment options. A second opinion may confirm your original doctor’s diagnosis and treatment plan, provide more details about the type and stage of breast cancer, change your original doctor’s diagnosis and treatment plan, raise additional treatment options you hadn’t considered, or recommend a different course of action.

This study, done by researchers at the Medical University of South Carolina (MUSC), included 70 people who were diagnosed with stage 0 to stage III breast cancer at a different institution and came to the MUSC multidisciplinary tumor board for a second opinion between August 2015 and March 2016.

Multidisciplinary tumor boards, as the name suggests, are boards made up of medical professionals from a variety of specialties within a specific cancer field (such as breast cancer), including radiation oncologists, surgical oncologists, medical oncologists, nurse navigators, geneticists, and pathologists. The experts review a person’s records and come to a consensus about a diagnosis and treatment plan. Multidisciplinary tumor boards are becoming the standard of care at many cancer centers.

In this study, the experts on the breast cancer multidisciplinary tumor board compared the people’s radiology, pathology, and genetic testing reports from the outside institutions with test results done at MUSC.

Overall, the tumor board recommended that 43 of the 70 people have additional imaging or biopsy, which found new cancers in 16 people. The tumor board also recommended that 11 people be referred for genetic testing; genetic testing had not been recommended at the outside institution. Based on the tumor board review and the board’s second opinion, 30 people (43%) had a change in diagnosis.

“Our results show our second opinion really does provide value in potentially changing the diagnosis, which in most cases will eventually change treatment,” said surgical oncologist Nancy DeMore, M.D., of the Hollings Cancer Center at the MUSC. “I would hope this study would empower patients to seek a second opinion at centers that specialize in oncology.

“Those findings would drastically change care,” she continued. “In addition, we found the pathology review changed in 20% of people. And 16% of people who met guidelines for genetic testing by the National Comprehensive Cancer Network guidelines for genetic testing had not been referred for testing.”

The very idea of getting a second opinion can seem overwhelming at first, especially when you’ve just been diagnosed with breast cancer. It can take time and legwork to find a second doctor, arrange for the second opinion, and deal with any insurance issues that may arise. It also can be intimidating to tell your current doctor you want a second opinion. But many people with breast cancer decide to get second opinions, and doctors are used to hearing this request. In fact, your doctor may be able to help you find another specialist who can provide a second opinion. Some insurance companies even require a second opinion before treatment begins. In general, delaying the start of treatment for a short time usually does not pose a risk, although you and your doctor can discuss your unique situation and decide how much of a delay is okay.

I cannot imagine not getting a second opinion. I did and I am glad. I went with the first surgeon but valued hearing almost the same treatment plan from the second. i just liked the first doctor and hospital better.

For more information, including deciding where to get a second opinion and how to make sense of a second opinion, visit the Breastcancer.org Getting a Second Opinion pages.

Update from American Cancer Society

From the American Cancer Society:

What’s New in Breast Cancer Research?

Researchers around the world are working to find better ways to prevent, detect, and treat breast cancer, and to improve the quality of life of patients and survivors.

Some of the many active areas of research include:

  • Breast cancer causes
  • Causes and treatment of metastatic breast cancer
  • Reducing breast cancer risk
  • Managing ductal carcinoma in situ (DCIS)
  • New lab tests for breast cancer
  • New imaging tests for breast cancer
  • Breast cancer treatment
  • Supportive care

Breast cancer causes

Studies continue to uncover lifestyle factors and habits, as well as inherited genes, that affect breast cancer risk. Here are a few examples:

  • Several studies are looking at the effect of exercise, weight gain or loss, and diet on risk.
  • Studies on the best use of genetic testing for breast cancer mutations continue at a rapid pace.
  • Scientists are exploring how common gene variations (small changes in genes that are not as significant as mutations) may affect breast cancer risk. Gene variants typically have only a modest effect on risk, but when taken together they could possibly have a large impact.
  • Possible environmental causes of breast cancer have also received more attention in recent years. While much of the science on this topic is still in its earliest stages, this is an area of active research.

Reducing breast cancer risk

Researchers continue to look for medicines that might help lower breast cancer risk, especially women who are at high risk.

  • Hormone therapy drugs are typically used to help treat breast cancer, but some might also help prevent it. Tamoxifen and raloxifene have been used for many years to prevent breast cancer.  More recent studies with another class of drugs called aromatase inhibitors (exemestane and anastrozole) have shown that these drugs are also very effective in preventing breast cancer
  • Other clinical trials are looking at non-hormonal drugs for breast cancer reduction. Drugs of interest include drugs for osteoporosis and bone metastases, COX-2 inhibitors, non-steroidal anti-inflammatory drugs, and statins (used to lower cholesterol).

When breast cancer spreads, it often goes to the bones. Some drugs that help treat the spread of cancer to the bones (such as bisphosphonates and denosumab), might also help reduce the chances of the cancer coming back. Studies done so far seem to suggest that postmenopausal women may benefit the most from giving these bone-modifying drugs after breast surgery, but more studies are needed to say for sure.

This type of research takes many years. It might be some time before meaningful results on any of these compounds are available.

Managing DCIS

In ductal carcinoma in situ (DCIS), the abnormal cells are in the milk duct and have not grown outside the duct.. In some women, DCIS turns into invasive breast cancer, or sometimes an area of DCIS contains invasive cancer. In other women, though, the cells just stay within the ducts and never invade deeper or spread to lymph nodes or other organs. The uncertainty about how DCIS will behave can make it hard to choose the best treatments. Researchers are looking for ways to help with these challenges.

Researchers are studying ways to use computers and statistical methods to estimate the odds that a woman’s DCIS will become invasive. Decision aids are another approach. They ask a woman with DCIS questions that help her decide which factors (such as survival, preventing recurrence, and side effects) she considers most important in choosing a treatment.

New lab tests

Tests for circulating tumor cells (CTCs)

Researchers have found that in many women with breast cancer, cells may break away from the tumor and enter the blood. These circulating tumor cells (CTCs) can be detected with sensitive lab tests. Although these tests can help predict which patients may have breast cancer that has spread beyond the breast (metastatic disease), it isn’t clear if the use of these tests can tell whether the cancer will come back after treatment (recur) or help patients live longer. Some studies are looking at if these CTCs can be removed and then tested in the lab to determine which specific anticancer drugs will work on the tumor.

New imaging tests

Newer imaging methods are now being studied for evaluating breast changes that may be cancer.

Scintimammography (molecular breast imaging)

In this test, a slightly radioactive drug called a tracer is injected into a vein. The tracer attaches to breast cancer cells and is detected by a special camera.

This technique is still being studied to see if it will be useful in finding breast cancers. Some doctors believe it may be helpful in looking at suspicious areas found by regular mammograms, but its exact role is still unclear. Current research is aimed at improving the technology and evaluating its use in specific situations such as in the dense breasts of younger women.

Breast cancer treatment

Chemotherapy

It is known that chemotherapy can be helpful for many breast cancer patients. But predicting who will benefit the most or the least is still being studied. Sometimes there are significant side effects (long- and short-term) from chemotherapy, so having tests that can determine who really needs chemo would be useful. Many studies are being done to evaluate different tests that can more accurately tell which patients would benefit from chemo and which patients could avoid it.

Oncoplastic surgery

Breast-conserving surgery (lumpectomy or partial mastectomy) can often be used for early-stage breast cancers. But for some women, it can result in breasts of different sizes and/or shapes. For larger tumors, it might not even be possible, and a mastectomy might be needed instead. Some doctors are addressing this problem by combining cancer surgery and plastic surgery techniques, known as oncoplastic surgery. This typically involves reshaping the breast at the time of the initial surgery, such as doing a partial breast reconstruction after breast-conserving surgery or a full reconstruction after mastectomy. Oncoplastic surgery may mean operating on the other breast as well to make the breasts more alike.

Triple-negative breast cancer

Since triple-negative breast cancers cannot be treated with hormone therapy or targeted therapy such as HER2 drugs, the treatment options are limited to chemotherapy. Other potential targets for new breast cancer drugs have been identified in recent years. Drugs based on these targets, such as kinase inhibitors and immunotherapy, are now being studied to treat triple-negative breast cancers, either by themselves, in combination, or with chemotherapy.

Targeted therapy drugs

Targeted therapies are a group of drugs that specifically target gene changes in cancer cells that help the cells grow or spread. New targeted therapies are being studied for use against breast cancer, including PARP inhibitors. These drugs are most likely to be helpful against cancers caused by BRCA gene mutations, and have shown some promise in treating some types of breast cancers. Olaparib (Lynparza) is now being used to treat women with BRCA mutations who have metastatic, HER2-negative breast cancer and who have already gotten chemotherapy. Other PARP inhibitors are also being studied.

Supportive care

There are trials looking at different medicines to try and improve memory and brain symptoms after chemotherapy. Other studies are evaluating if certain cardiac drugs, known as beta-blockers, can prevent the heart damage sometimes caused by the common breast cancer chemotherapy drugs, doxorubicin and epirubicin.

Thinking about taking part in a clinical trial

Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases, they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials, or see Clinical Trials to learn more.

Breast Cancer Awareness Month 2018

Taking place annually throughout the month of October, Breast Cancer Awareness Month aims to raise awareness about the disease and raise funds for research into its cause, prevention, diagnosis, treatment and cure.

If you have not had a mammogram, now is the time to schedule one. Early detection saves lives.  In 2012, I was diagnosed after an annual mammogram with Stage 1 lobular carcinoma. Surgery by the amazing surgeon Dahlia Sataloff and radiation by the amazing radiologist Marisa Weiss as well as Tamoxifin by the fabulous oncologist David Mintzer, has kept me healthy for 6 years… and counting.