For the last week, I have been getting up in the middle of the night. Nothing is really on my mind- nothing that I wake up thinking about. I am just up. Anywhere between 3- 5 AM. Unusual for me. I am a sleeper and, though I do not go to bed early, I like to sleep late. Finally this week, I realized that my anxiety (which is what wakes me up between 3- 5 AM) is about the annual mammogram I am scheduled for on May 5.
This is the third year since my diagnosis and treatment for lobular cancer in my right breast. I had radiation for 8 weeks at Lankenau Hospital with Dr Marisa Weiss after surgery at Pennsylvania Hopsital with Dr Dahlia Sataloff. My oncologist is Dr David Mintzer at Pennsylvania Hospital. May is my check up month and I have appointments later in the month with Sataloff and Mintzer.
No doubt that I am nervous about the test. My body tells me so by waking me up. But mammograms save lives, find cancer early and are necessary for good health.I just hope all is well and they find nothing. Then I can sleep through the night for another year!
October is Breast Cancer Awareness Month. The chance of a woman having invasive breast cancer during her life is about 1 in 8. Ashkenazi Jews have an even higher incidence of breast cancer than the general population. But breast cancer is no longer an automatic death sentence. With early diagnosis and new treatments, there are now more than 2.8 million breast cancer survivors in the United States.
The recent recommendations based on a population-based study published in Proceedings of the National Academy Sciences urge all Jewish women of Ashkenazi descent to be tested for mutations on the BRCA 1 and 2 genes that are associated with a higher risk of breast cancer. Leading oncologist Prof. Tamar Peretz, Interim Director General of Hadassah Medical Organization and Director of Hadassah’s Sharett Institute of Oncology in Israel, rejects universal testing:
“Jewish women without a family history of breast and ovarian cancer should not feel pressured to undergo the BRCA test for breast and ovarian cancer. The implications of the BRCA test are complex. Many women will get results without being able to discuss them with a qualified clinician. I fear that without using discretion in administering this test, and without coupling it with genetic counseling by an experienced health professional, the search for BRCA gene mutations can harm more lives than it saves.”
“As for the recommendation by certain scientists that Jewish Ashkenazi women be tested by age 30, we know that many Jewish women aren’t married by age 30, and if they are, few have completed their childbearing years. Prophylactic removal of a woman’s ovaries and breasts can have a devastating impact on her life. We have not yet determined that the psychological burden of knowing outweighs the risk of discovering this gene later.”
“Jewish women without family histories should make use of other examination modalities, in addition to avoiding obesity and heavy drinking, two factors linked with breast cancer.”
Hadassah Medical Organization was the first to conduct the BRCA tests on Jewish women, along with the National Institutes of Health (NIH), in 1995, confirming that postulated prevalence of the gene mutation in the Ashkenazi community, which includes approximately three million women living in the United States. In all, one in forty Jewish women and men carry a mutation on one of the BRCA genes, as compared to one in 345 men and women in the general population.
Hadassah has a new initiative called the Uplift Project: Supporting Breast Cancer from A to DD. People submit decorated bras. Learn more about it: The Uplift Project
October is Breast Cancer Awareness Month, which is an annual campaign to increase awareness of the disease. While most people are aware of breast cancer, many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same. We have made a lot of progress but still have a long way to go and need your help!
Think Pink, Live Green is a way of living that aims to help women reduce their risk of breast cancer or the disease coming back in survivors. It’s also a way for women living with advanced disease to make the healthiest choices possible. One of the most important involves sleep!
Here is an article by Dr. Marisa Weiss from Breastcancer.org:
Researchers are discovering that sleeping problems can cause weight gain, and being overweight can cause sleeping problems. It’s a vicious cycle. That’s why both getting enough Zs and maintaining a healthy weight are important to your overall health — plus they also help reduce the risk of breast cancer and speed recovery after treatment for the disease.
Those of us with breast cancer, now or in the past, often have sleep troubles. Plus, many of us were already overweight before diagnosis and then gained more weight through and beyond breast cancer treatment. Big surgeries and being under anesthesia for a long time cause pain, disrupt our body’s normal schedule, and decondition our muscle, heart, and lung function. Steroids during and after chemo can make us hungrier and put on more weight. Chemo can change our taste buds and make us crave high-calorie comfort foods. Plus, eating can temporarily soothe the uncomfortable emotions that go along with a breast cancer diagnosis: uncertainty, anxiety, anger, and depression. These are all very mean side effects of an already very upsetting situation.
But we’re not alone: two-thirds of American adult women are considered overweight or obese. This statistic goes hand in hand with the decline in sleep in America. In the last 50 years, the average daily time we sleep has dropped by 1.5 to 2 hours. A recent study found that more than 30% of participants said they got less than 6 hours sleep per night. Sometimes that’s by choice, but usually not. Another large study found that about 1 in 5 people suffer from a sleep disturbance (such as a newborn baby waking them up or constant jet lag). Nearly 1 in 10 had a medical sleep disorder such as insomnia or obstructive sleep apnea.
As with any cycle, you probably wonder which came first: being overweight or sleeping problems? It’s one of those chicken and egg questions. While researchers keep working to figure out the relationship between lack of sleep and being overweight, one thing is clear: Not sleeping enough may stop you from losing weight even if you’re eating right and exercising regularly. This is because our sleep patterns affect our metabolic system, which regulates the production of energy that fuels all of our body functions. Metabolic upset can lead to a host of other health problems.
Breaking the cycle
To lose weight, sleep time may matter more than gym time. Studies have shown that people who get enough sleep tend to have stable weight and stable blood sugar levels. The magic number for sleep seems to be 7 to 8 hours nightly. Still, many of us function even better with more than 8.
Let’s see how sleep and weight issues interact, how they may affect you, and how to break the cycle.
Sleep issues and appetite
Research shows there’s a fairly consistent relationship between sleeping less than 6 or 7 hours per night and the risk of being overweight or obese. A very large study of older people found that men and women who got by on about 5 hours of sleep per night tended to gain more weight than those who got 7 to 8 hours of sleep. People who got less than 4 hours sleep per night had a 40% greater risk of becoming obese compared to the healthy sleepers. A Swedish study found that “short sleepers” were more likely to be obese (and to have many poor health and lifestyle habits) than people who slept 6 to 9 hours per night.
Why does this happen? Eating too much causes weight gain, and lack of sleep turns out to play a role in our eating habits.
If you’re awake longer, you have more chances to eat. But why, when, and how much we eat are partly controlled by hormones that regulate how our bodies use energy, also known as metabolism. Sleep loss affects the hormones that control appetite. One hormone, ghrelin, increases appetite and makes us feel hungry. Another hormone, leptin, decreases our appetite and makes us feel full. The less sleep you get, the less normal these hormone levels are. Your body makes more ghrelin and less leptin. This means you’re more likely to feel hungry and eat more, which could lead to extra pounds.
Also, sleep deprivation creates changes in the brain that lead us to crave high-calorie, high-fat foods — and make us less able to stop ourselves from eating them. Sleep loss also seems to trigger emotional eating in people (especially women) prone to munch during stressful times.
Sleep and metabolism
So we know a lack of sleep upsets metabolism. When your metabolism is upset, it also messes up your circadian rhythms — the body’s internal schedule for when you’re supposed to eat, sleep, and be active.
One of your internal clock’s functions is to regulate insulin (which controls blood sugar levels and how much fat you store), growth and stress hormones, and immune system actions (particularly inflammation). Inflammation is your body’s response to a threat. Signs of inflammation include swelling, warmth, redness, and pain. All these symptoms mean your body is trying to fix anything that’s damaged or trying to get rid of something harmful, such as a virus or bacterium.
Insulin resistance means your body stops responding to insulin the way it should. To learn more about insulin resistance, read one of my earlier Think Pink, Live Green columns, The Ins and Outs of Insulin Resistance.
Not getting enough sleep can also have a bad effect on insulin regulation and increases the risk of diabetes. A study that allowed healthy young adults only 4 hours of sleep per night for just one week found that some of the participants’ insulin and blood sugar levels were similar to the levels of people with diabetes.
Still, the biggest concern is developing metabolic syndrome, a group of risk factors for heart disease and cancer that includes high blood pressure, blood sugar, and cholesterol levels. Studies have found that people who don’t get enough sleep had a higher risk of developing metabolic syndrome. And guess what? These metabolic problems can disturb your sleep — another vicious circle. Yikes, this stuff is complicated.
Even if you always go to bed on time, you may not be able to sleep well due to obstructive sleep apnea. Sleep apnea is a fairly common medical condition. While you’re sleeping, the airway in your throat collapses or becomes blocked. You may even briefly stop breathing, which then wakes you up. Apnea is more common in overweight people, and most extremely obese people suffer from it. Like any sleep disorder, sleep apnea can cause metabolic changes, raising the risk of being overweight even if you’re currently at a healthy weight. This creates another unhealthy feedback loop (less sleep, more hunger; more hunger, more food, and so on). People with sleep apnea, especially if they are also obese, tend to have more metabolic problems, including diabetes.
The breast cancer connection
When it comes to the risk of developing breast cancer, there doesn’t seem to be a link between sleep and the disease. But there is a connection between aging and breast cancer risk: the older you are, the higher the risk. Aging involves all the wear and tear of living, as well as environmental exposures. Sleep is when you repair a lot of these everyday stresses and strains to your system. With or without breast cancer — but especially if you’ve had the disease — sleep quality can play a big role in how well you feel, function, heal, and recover.
Sleeping problems have been found to show up before and after breast cancer surgery, and most chemotherapy patients have temporary sleep issues. Many women who’ve had chemotherapy have ongoing sleep problems, especially if they are very overweight.
If you’re a regular reader of this column, you know that overweight and obese women have a higher risk of developing breast cancer in the first place. They also have a higher risk of the breast cancer coming back (recurrence), especially if they carry extra fat in their midsection. This is partly because the extra fat cells make a lot of extra hormones that can lead to extra breast cell growth. The extra hormones include estrogen, insulin growth factors, prostaglandins, and others. When you have higher levels of these hormones in your blood over time, the risk of cancer is increased. Extra weight also is connected to inflammation, which puts stress and strain on your immune system and breast cells. A lot of new research shows a link between weight-related inflammation and breast cancer risk.
Rest for success
Thankfully, better sleep promotes weight loss and vice-versa. If you’re struggling to get good sleep and stick to a healthy weight, here are some tips to get back on track:
- Make time in your schedule for 7 to 8 hours of sleep nightly — no excuses!
- Retrain your body’s internal clock. Start and stick to a regular schedule of eating, exercising, and sleeping.
- Figure out the cause of your sleep issues. Often changing or shifting a habit, activity, or behavior can make a big difference.
- Break the caffeine cycle. Drink fewer caffeinated beverages such as coffee, tea, soda, and energy drinks. I’ve had to cut back to only one caffeine beverage per day, which I have to drink before noon. Drinking coffee or soda all day to boost your energy will likely make it harder to fall and stay asleep at night. Plus, if you’re fan of sugary, caffeinated drinks, they can add pounds.
- Keep your bedroom dark and avoid using electronic devices such as cell phones, tablets, and video games right before your go to bed. Light — especially the blue light given off by computer screens and energy-efficient light bulbs — suppresses an important hormone called melatonin. Melatonin helps regulate sleep. Some researchers think normal melatonin levels also can help maintain normal cell growth and that low levels of melatonin may contribute to the risk of developing cancer. If you work a night shift or must use devices after dark, buy a special blue-light filter.
- Get treatment for sleep problems with a medical cause:
- If you have obstructive sleep apnea or severe snoring, talk to your doctor. Experts recommend treating the apnea first, before dealing with any related extra weight. That way, you’ll be rested enough to start exercising. Your doctor may prescribe a CPAP (continuous positive airway pressure) machine to help you breathe at night.
- If you have breast cancer-treatment-related insomnia or sleep disturbance, try some of the tips in my column Sleep Well: Turn In, Tune Out, and Unplug. Complementary medicine techniques such as meditation, yoga, and acupuncture might also help. Check out the Breastcancer.org section on Complementary and Holistic Medicine for more information.
- Avoid widely prescribed hypnotic sleeping medicines, especially after a breast cancer diagnosis. This class of medicines includes Ambien (chemical name: zolpidem), Halcion (chemical name: triazolam), Sonata (chemical name: zaleplon), and Lunesta (chemical name: eszopiclone). A very large study published in 2012 found that users of hypnotic sleeping medicines (especially people who took them often) had a much higher risk of death or being diagnosed with cancer than non-users. Also, each of these medicines can have many problematic side effects. For example, Ambien and Halcion have been associated with walking, eating, and even driving while asleep. The U.S. Food and Drug Administration recently halved the recommended dose of Lunesta because that medicine can make it difficult to drive and may affect memory and coordination the day after taking it. All of these medicines may be habit-forming and cause withdrawal symptoms if stopped suddenly.
- Cognitive behavioral therapy, a special type of counseling that doesn’t use medicine and focuses on changing one’s thoughts, may help with sleep.
- Try some of the diet and exercise tips in the Breastcancer.org Lower Your Risk Besides burning calories, exercise also promotes better sleep. But remember, work out at least 3 hours before bedtime or you’ll be too revved up to sleep.
Have you ever had problems sleeping? What did you do to get more sleep?
I had my annual mammogram scheduled and, as usual, had trepidations and fears leading up to it. Every time for the last few years, I had had to get extra pictures and sonograms taken and the whole process took hours. I go to Jefferson- Honickman Breast Imaging Center where they tell you the results immediately so I always left knowing and was glad when things were okay, until they were not in May of 2012 when they found something they felt was serious and needed attention.
Last year was the first post cancer mammogram and it took almost 4 hours. I blogged about it before (see last blog entry) because it was so scary. As I was driving in today, I though how nice it would be to get a mammogram and have it go smoothly. Take the pictures, sure it’s pressure and uncomfortable, but so what? This is a life saving procedure. A few uncomfortable minutes is not worth mentioning. But it I only have to go through it once, that would be great. Hasn’t happened in years.
But what do you know? Today, they called my name and told me A-OK, Nothing was wrong. It all looked fine and I could go home. What relief poured over me. I waited for copies of the digital pictures because Dr. Dahlia Sataloff, my most amazing surgeon, likes to read them herself, not just read the report. I see her later in May.
Today was a good day!
Last week I got a call from a friend of a friend whose diagnosis was the same as mine- stage one lobular breast cancer. Her options, however, were so different from those offered to me! It seems that now research has shown that if you are estrogen positive (as I am) and as she is, you can take Tamoxifen or Arimidex and skip radiation and get the same outcome. And she told me, even if you do radiation, it is for 3 weeks, not 6 at her hospital in Washington, DC.
Medical research changes things so quickly! Her doctor tends to be more traditional but she is looking into everything and then she will decide on her course of action.
That’s what we do. We get the best care at the moment and hope for the best. My course of action was surgery- lumpectomy, 6 weeks of radiation and now Tamoxifen because I could not tolerate Arimidex.
I made the appointment for my next mammogram in April. I go to Jefferson- Honickman Breast Imaging Center where I have been going for years. I trust their radiologists, especially Dr. Tara Rosenberg who found the cancer in the first place. Now, I hope she finds nothing!!
Tamoxifen’s Mental Side Effects Are Real, Study Shows
Tuesday, September 17, 2013
TUESDAY, Sept. 17 (HealthDay News) — Some women who take tamoxifen to treat or prevent breast cancer report experiencing a mental fogginess while on the drug, and researchers have now confirmed that there’s a biological basis for those symptoms.
The researchers were able to isolate the cells in the human brain and nervous system that are harmed by tamoxifen therapy. And, in a second phase of the study conducted with mice, they were also able to find a different drug that could protect healthy cells from tamoxifen toxicity while offering no protection to cancer cells.
“Patients aren’t always taken seriously when they report these mental side effects, but now we can say this is an organic syndrome to which we have to pay attention,” said Mark Noble, senior study author.
“And, now we know there are paths to protection. This is not a hopeless situation,” added Noble, a professor of biomedical genetics, and director of the University of Rochester Stem Cell and Regenerative Medicine Institute, in Rochester, N.Y.
Tamoxifen works by blocking the action of estrogen in breast tissue, which keeps estrogen-sensitive breast cancers from growing, according to the U.S. National Cancer Institute. Compared to other forms of cancer treatments, it has relatively few serious side effects. However, in some women who take it, tamoxifen causes problems with thinking.
One expert was pleased to see new scientific support for what she’s observed in her clinical practice.
“There is a subset of women who report this mental fog while on tamoxifen. Often, this improves over time. They initially experience this very noticeable side effect, but then it improves. We often tell women to try to stick it out because it may get better,” said Dr. Jane Carleton, a breast cancer specialist at the North Shore-LIJ Cancer Institute in Lake Success, N.Y., who was not involved with the new study.
Carleton said she was happy to see that the current study was able to validate that there was a reason that some women experience the mental fog while taking tamoxifen. And, she said she was even happier to see that there might be a potential treatment for this side effect.
“Every time we can improve quality of life and still treat cancer, it’s a win,” she said, but noted that it would still be years before this drug might be available.
For the study, Noble and his research team first sought to identify whether brain and central nervous system cells were sensitive to tamoxifen. They found one type of cell that was particularly vulnerable to the drug. After just two days of exposure to tamoxifen at levels similar to those someone in treatment would receive, 75 percent of these cells died.
“Tamoxifen causes cell death and suppression of cell division in these cells,” Noble said.
The next step was to try to find a medication that could protect these cells from tamoxifen while still allowing the drug to keep its cancer-fighting ability. The researchers reviewed data on drugs that were already approved for use in humans or that were in clinical trials.
Noble said by looking at these types of drugs, they could save time because they already know that such drugs work in the body and that they’re not toxic. They found one drug, currently called AZD6244, that protected the brain cells of mice against tamoxifen in their own study.
Scientists note, however, that research with animals often fails to provide similar results in humans.
“AZD6244 is being studied for cancer therapy. It protects normal cells, but it doesn’t protect cancer cells. It may even make cancer cells more sensitive to some types of therapies,” Noble said.
Noble said this work needs to be replicated by other researchers, and added that “it’s essential that we find ways of treating cancer without causing this type of damage.”
Results of the study were published online Sept. 17 in the Journal of Neuroscience.
SOURCES: Mark Noble, Ph.D., professor, biomedical genetics, and director, Stem Cell and Regenerative Medicine Institute, University of Rochester Medical Center, Rochester, N.Y.; Jane Carleton, M.D., breast cancer specialist, North Shore-LIJ Cancer Institute, Lake Success, N.Y.; Sept. 17, 2013, Journal of Neuroscience, online